The association of Kallmann’s syndrome with conductive hearing loss has not previously been described. We report the findings at tympanotomy in three ears of patients with Kallmann’s syndrome and conductive deafness. The literature related to this topic is reviewed, and the treatment of these patients is discussed.

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following

(1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears.

(2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation.

(3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed postoperative hearing results and suggest surgical guidelines in order to optimize the post-operative results.

(4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.

Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacousticemissions, tympanometry and otoscopy. An age- and sex- matched control was recruited for each patient and the incidence of acute otitis media and OME was compared between the twogroups. One hundred and twenty-four children with meningitis were studied. Ninety-two children (74 per cent) had meningococcal meningitis. Five patients (4 per cent) had conductive hearing loss (ABR threshold≥30 dB HL) at the time of discharge from hospital. None of the patients or controls had acute otitis media. Patients and controls were well matched for risk factors for OME and the prevalence of middle ear effusion in patients and controls was 7.2 per cent and 11.3 per cent respectively. The relative risk of OME in the children with meningitis was 0.64 (95 per cent confidence interval 0.29 to 1.42). After nine months, three of the five children with meningitis and conductive hearing loss had regained normal hearing.

In contrast to previous reports, there was no relationship between bacterial meningitis and acute otitis media or OME in this study. Nevertheless, coincidental conductive hearing defects were identified as the cause of reversible hearing loss in three patients.

Non-explosive blast injury of the ear refers to the otological trauma caused by a blow to the ear that seals the external auditory meatus. It results in a sudden increase of air pressure within the ear canal that strikes the tympanic membrane. The present study portrays the various aspects of middle and inner ear damage in 91 patients resulting from an assault we entitled a ’non-explosive blast injury' to the ear. Sixty cases were caused by a slap or a fist, 13 patients suffered sport accidents, mostly in ball games, and 18 patients were injured during swimming and water sports activities. The common symptoms were hearing loss, earache, tinnitus, vertigo and otorrhoea. All 91 patients presented with acute perforations of their eardrums. The mean conductive hearing loss was 11.2 dB. A high tone sensorineural hearing loss was detected in only 20 per cent of the patients. A spontaneous closure of the perforation with a conservative management approach was observed in 94.8 per cent of the patientsHealing of the perforation was always associated with closure of the air-bone gap, while the results of the sensorineural hearing loss recovery were less favourable.

A case of a moderate essentially low tone unilateral conductive hearing loss without a previous history of secretory otitis media in a six-year-old female patient is described. The condition was found to be due to a dermoid cyst in the tympanic cavity, which was confirmed by pathological examination of the surgically removed specimen. This is the sixth documented case of dermoid cyst in the tympanic cavity.

Hearing loss as a frequent complication of louse–bome epidemic typhus fever has been well documented in the reports of ENT specialists serving in both the Allied and the German armies in the last war. The present paper describes the characteristic histopathological features as noted in sections of the temporal bones from five British soldiers who died in 1944 of typhus fever during the last war in Eastern Asia. The VHIth nerve showed multiple ‘typhus nodules’ and there was extensive interstitial neuritis of the VHIth nerve and demyelination of the nerve fibres. There were also widely scattered aggregations of mononuclear cells in the inner ear.

This unique study was based on the Hallpike collection of temporal bone sections.

The objective of this paper is to compare two methods of predicting the level of subjective patient benefit following reconstructive middle ear surgery. This should have always been an important consideration in advising patients regarding surgery, but assumes even more relevance in these days of clinical audit and cost benefit analysis. The two methods studied were the ‘15/30 dB rule of thumb’ (Smyth and Patterson, 1985) and the ‘Glasgow plot’ (Browning et al., 1991). The predictions of benefit for each of the two methods were compared to the assessment of actual benefits by the patient post-operatively. The results of this comparison in 153 patients were analysed, the rule of thumb was found to be somewhat more sensitive in predicting patient benefit.

Two cases are presented of bilateral conductive deafness in siblings. An initial presumptive diagnosis of otosclerosis was made in the first case, that of a nine-year-old girl with a bilateral hearing loss of 45 dB. Exploratory tympanotomy revealed normal ossicles but the stapedius ‘tendon’ was found to be a solid bony bar fixing the stapes. Division of the ‘tendon’ resulted in normal ossicular mobility and return of hearing with closure of the air-bone gap. Identical ossification was found in her other ear, and some years later in both ears of one of her brothers. Similar surgery restored hearing successfully in each case. An acquired aetiology has been proposed in one of the three previously reported cases; this report, however, suggests the congenital nature of the anomaly. No previous cases have been described occurring in siblings.

Fifty members of a family with a unique autosomal dominant bone disease were investigated. Nineteen of the family members were either known to have, or were strongly suspected of having the disease. All but one of these had a hearing loss which was conductive in the younger age group and mixed in the older members. The common finding in those who had middle ear surgery was replacement of the long process of incus by a fibrous band. The histological features were similar to those found in Paget's disease. The age of onset, distribution of lesions and radiographic findings, however, were not typical of this disorder.