A secretory activity has recently been attributed to the endolymphatic sac (ES), as a possible way to contribute to the fluid balance of the entire endolymphatic compartment. Previous histochemical studies have indicated the existence of carbohydrate complexes in the secretory product, both neutral and acidic in nature.

A thorough analysis of these compounds in the gerbilline ES was carried out using both transmission electron microscopic (TEM) histochemistry, using dialyzed iron and periodic acid—chromic—silver staining techniques, as well as immunoflourescence with fluorescein-labelled lectins (FITC-lectins).

N-acetylglucosamine was found to be one of the major carbodhydrate components both of the epithelial layer of the ES and of the luminal precipitate. Proofs for a local secretory activity and its intracellular pathway are presented, suggesting to be involved in the regulation of pressure and volume of inner ear fluids.

Single stage surgery was used for 174 operations for cholesteatoma. The results were analysed using months at risk (actuarial) statistics. The methods of data collection and of creating a life-table for cholesteatoma follow-up are described. Ninety-one canal-down procedures are compared with 82 canal-up procedures as to the recidivism rate as well as hearing results. The actuarial tables showed a 50 per cent cumulative success rate for canal-up procedures versus a 90 per cent rate for canal-down operations. The successful canal-up procedures, however, demonstrated slightly better hearing results. These success rates seemed to be comparable to those using planned staged surgery.

It was concluded that if single stage canal-up procedures were used with larger mastoids and canal-down procedures with smaller mastoids, 80 per cent of patients could be controlled without either residual or recurrent disease appearing. For the others, it was felt safe to wait for the disease to reappear rather than to do planned two-stage procedures for all patients. It was further urged that actuarial statisties be employed when reporting the results of surgery for cholesteatoma.

To obtain the best possible results of treatment of acquired cholesteatoma, we made a subdivision of cholesteatoma types into attic and pars tensa cholesteatomas, and subdivided the latter further into tensa retraction cholesteatoma and sinus cholesteatomas. Tensa retraction cholesteatoma is defined as arising from a retraction or perforation of the whole pars tensa, whereas sinus cholesteatoma is defined as arising from a retraction or perforation of the postero-superior part of the tensa. We present the long-term results obtained in tensa retraction cholesteatomas treated with one stage surgery from 1964 to 1980. Median observation time was 9 years, range 2 to 19 years. Sixty-one ears were treated without mastoidectomy, whereas 71 ears had canal wall-up mastoidectomy and 64 ears had canal wall-down mastoidectomy. The total recurrence rate was 13.3 per cent; 17 ears had residual cholesteatoma, and nine ears had recurrent cholesteatoma. The best results were obtained in ears with an intact ossicular chain where mastoidectomy was not performed. In 49 per cent of the cases, the cholesteatoma was confined to the tympanic cavity without reaching the aditus, antrum or mastoid process. About one-third to one-quarter of the ears had tympanoplasty only, with removal of the cholesteatoma through the ear canal.

A statistical study was done on the sensorineural component in hearing loss, using 595 patients suffering from Chronic Otitis Media (COM); of these, 195 with monolateral COM were taken into consideration. They presented criteria of valuation which excluded other possible causes of sensorineural hearing loss, such as exposure to acoustic trauma, ototoxic drugs, cardiovascular disease, past head injury and hereditary causes. The contralateral (healthy) ear served as a control. We determined the average sensorineural component in the hearing losses in relation to the age of onset and duration of the disease, examining it in relation to other eventual aural complications such as cholesteatoma.

On the basis of the data obtained, we believe that the sensorineural component in hearing loss does not change with respect to the age of onset of COM, but the duration of COM does exert a significant influence.

Hearing threshold of 30 diabetic patients and 30 healthy controls attending the medical outpatient department were determined using pure tone audiometry (Arphi Digital 900). All subjects were less than 50 years old. Subjects with otological and other metabolic diseases were excluded from the study. The patients were categorized into groups according to age, duration of disease, complications and control of diabetes. These observations were compared with those from the control subjects using appropriate statistical methods.

It was found that diabetics had a poorer hearing threshold than the non-diabetics; all age groups with diabetes showed a significant high frequency hearing loss, as compared to the control population; poorly controlled and complicated diabetics have significant, high frequency hearing loss as compared to those who were well controlled and uncomplicated; there was no relationship between duration of the diabetes and the level of hearing loss.

A retrospective analysis of 76 patients who underwent acoustic neuroma removal is reported. Facial nerve function prior to surgery and tumour size are assessed with respect to final facial nerver recovery and the need for surgical rehabilitation. Both pre-operative facial weakness and tumour size greater than 2.5 cm. are shown to be predictive factors of poor facial nerve recovery. Multiple surgical rehabilitative procedures are often required when inadequate function and/or cosmetic results are obtained. Primary nerve repair and facial-hypoglossal anastomosis give better rehabilitative results than dynamic and static procedures. The association of tumour size greater than 2.5 cm. with increased risk of poor facial recovery re-emphasizes the need to detect and remove acoustic neuromas at an early stage.

Sixty patients investigated for a suspected acoustic neuroma were questioned on the side effects of CT air meatography, a minimum of three months following the procedure. Twelve per cent of patients found the procedure itself so painful that a repeat examination would only be contemplated under general anaesthesia. Only 20 per cent of patients were asymptomatic after the procedure while 28 per cent of patients required bed rest for 24 hours or more (average 4.4±2.8 days). Sixty-two per cent of patients took three days or longer to return to normal health.

The duration and frequency of side effects is greater than previously reported, and emphasizes the need for full investigation of these patients prior to CT air meatography.

Every year 400 to 450 cases of Rhinosporidium are reported from Trivandrum Medical College. Twenty five swabs were collected from patients suffering from Rhinosporidiosis and cultured in standard media. Positive results were obtained in 23 cases. The conidia produced from the colony were compared with the structures obtained from the patient material. Light microscopy using histopathological techniques were used. The consistant appearance of the organism in patient material, the repeatability of growth in subcultures and the negative growth in controls indicated that the organism grown in cultures is the causative agent of the disease. The effect of parameters like pH, temperatures, etc, were also studied.

The results of 25 years of quasi-routine total parotidectomy performance are shown. At the Department of Otolaryngology of the University of Florence, 582 patients were treated as follows: on 527 occasions by total parotidectomy with facial never preservation; 24 occasions by lateral lobectomy; 27 occasions by total parotidectomy with removal of the whole facial nerve; four times by enucleo-resection of the disease. Benign tumours were 378; primary and metastatic malignant tumours—100; non tumoral lesions—104.

The benign tumours follow-up showed three recurrences only (two pleomorphic adenomas—one of them proved to be an adenoid-cystic carcinoma, and one monomorphic adenoma, which also proved to be an adenoid-cystic carcinoma), respectively 6, 6 and 8 years later. The malignant tumours were also treated by total parotidectomy with adequate management both of the facial nerve and the neck lymph nodes. The results thoroughly justify the nerve preservation, when preserved.

The aim of the study was to examine the incidence of croup in the Swansea area and to determine whether meteorological factors have any effect on the incidence of acute laryngotracheitis requiring hospitalization.

447 patients with a diagnosis of acute viral croup were admitted to the Ear, Nose and Throat Department of Singleton Hospital, Swansea, between January 1st 1980 and December 31st 1984.

There was no significant difference between days with and without croup admissions, with respect to barometric pressure or relative humidity. Maximum and minimum temperatures were significantly lower on days with croup admissions (p>0.001).

Wind direction appeared to influence the number of admissions, which were increased when the wind was from the south-east (p>0.01).

Cricothyroid muscle paralysis is often missed as the symptoms are not dramatic and the laryngeal observations, on conventional indirect mirror examination, are inconclusive. The anatomy and physiology of the superior laryngeal nerve (SLN) and cricothyroid muscle are described. Three case reports are presented to illustrate our diagnostic techniques. Videofibrolaryngoscopy and electromyography are found to be invaluable tools for the diagnosis of this condition. The importance in diagnosing this entity is discussed.

Aspiration into the lower respiratory tract can be detrimental to life. Ten patients, suffering from neurological dysphagia with aspiration, were studied. Neurological disorders can cause inadequate glottic closure resulting in aspiration. It has not been well recognized however, that even patients who have full glottic closure are still capable of aspirating in the pre- and post-deglutition stages of swallowing. The combined techniques of videofibrolaryngoscopy and videofluoroscopy are found to be the best methods for demonstrating these abnoralities. Development of new techniques, in the prevention of aspiration, should also take into account silent, pre- and post-deglutitional aspiration.

Serum 5-nucleotidase levels have been estimated in a group of 50 patients with head and neck cancer. The mean value was significantly higher in patients compared to the controls. In patients with non-malignant growths, the activity was comparable with the controls. The increase was higher in patients with proliferative lesions than those with ulcerative growths. Enzyme activity was found to be increased with the advancement in the stage of cancer. The rise was comparatively higher in patients with cervical metastasis. After radiotherapy, a gradual and significant reduction of serum 5-nucleotidase activity was observed.

A patient developed benign paroxysmal positional vertigo following partial excision of the upper jaw for squamous carcinoma. It is probable that the trauma sustained by the labyrinth during surgery led to the development of vertigo. Benign paroxysmal positional vertigo may be a preventable post-operative complication.

This case report describes the clinical course of a patient with Ramsay Hunt Syndrome. Partial recovery of the lower motor neuron facial palsy was associated with decreased hearing and a reduction of the middle ear compliance on voluntary contraction of the facial musculature. It is suggested that this is due to misdirection of regenerating nerve fibres, normally destined for facial muscles, to stapedius muscle.

A 46-year-old male was admitted to an intensive care unit: for 11 days he was ventilated via a naso-tracheal tube. Because of excess tracheal secretions, a mini tracheotomy was attempted on the unit which resulted in profuse arterial haemorrhage, necessitating immediate reintubation and subsequent formal tracheostomy. The authors feel that this complication was due to a mid-line vertical incision and that this could have been avoided by a horizontal incision across the lower part of the cricothyroid membrane, as close to the cricoid cartilage as possible. They describe their recommended technique.

Pedunculated squamous papillomas usually arise from the soft palate, tonsil or the epiglottis. These lesions can sometimes prove to be fatal. A case of peduculated squamous papilloma, arising from the laryngopharynx, in a young, mentally retarded female, is presented here. The clinical presentation, the site of origin and the size of the lesion were quite unusual. The narrow base of the pedicle made the intra-oral excision possible.