Doubt has been raised about the long-term suitability of ossicular implants in tympanoplasty. Twenty-three ossicular implants that had been in the middle ear for a mean duration of 9.6 years were examined histologically by light microscopy. Although there were only two specimens showing subtotal replacement of the dead ossicular implant by new bone, the structural integrity of all implants was maintained and there was no evidence of overt osteoclastic bone resorption. Therefore our findings support the concept of prolonged survival of ossicular implants in the middle ear and we do not see any good reason for abandoning their use in reconstructive tympanoplasty.

Microfractures of the temporal bone have been recognized for more than seventy years and occur in certain well-defined areas of the otic capsule. The etiology and significance of these microfractures has been debated since their discovery. The most commonly held theory is that they result from stresses within the otic capsule that develop with growth. An alternative explanation might be that they result from masticatory stress placed upon the temporal bone.

Fifty serially-sectioned temporal bones from the Ontario Temporal Bone Bank were examined in this study for the presence of microfractures. Our findings as to the most common sites of microfractures agree with previous studies.

It is proposed that the constant stress placed upon the petrous temporal bone by the act of mastication is directed by the anatomy of the external, middle and inner ear through certain definite pathways, including the Fallopian canal, the bony semicircular canals and the cochlea. The most common sites of these fractures represent sites of weakness in the path of these directed forces within the otic capsule, and the statistically significant increase in the number of fractures with age lends support to the masticatory stress theory.

The process of development of the crista ampullaris has been investigated in the mouse using SEM.

Cristae ampullaris of the CBA/CBA mice, from the 13.5th gestational day to the day 2 weeks by were studied.

On the 13.5th gestational day, there were numerous microvilli and a primary cilium on the crista ampullaris. Sensory hairs first appeared on the 14.5th gestational day. The kinocilium and stereocilia were short and the length of the stereocilia was almost constant. The formation of the cupula, which had fine networklike structures, started on the 14.5th gestational day.

Twelve normal adults were evaluated to determine their capacity to suppress caloric-induced nystagmus by visual fixation. Fixation suppression (FS) was assessed four times during the routine Fitzgerald-Hallpike caloric procedure. The results were characterized by large inter-subject as well as intra-subject variability. It is cautioned that diagnostic categories should not be inferred on the basis of absolute numeric values of FS.

This essay examines two possible mechanisms whereby a neuropathy affecting the efferent vestibular innervation may cause incoordination of vestibular afferent input to the Vestibular Integrating Centres: firstly, by loss of the normal fine control of afferent impulses; secondly, by a disruption of the sodium-potassium pump mechanism that maintains the ionic stability of the inner ear fluids.

The 1972 AAOO committee (Alford, 1972) guidelines brought some uniformity into the evaluation of therapy for Meniere's Disease. We have adhered to its recommendations in this long-term follow-up report of 21 saccus decompressions and 29 vestibular nerve sections performed on 46 patients between 1968 and 1977. Comparisons between these and other groups have been possible with regard to: 1. control of vertigo; 2. hearing; 3. tinnitus; and 4. development of hydrops in the contralateral ear. All the vestibular nerve section group have enjoyed sustained relief from vertigo. Class D results (recurrent vertigo) account for 14 per cent of the saccus decompression group at one year and 29 per cent at eight to 10-year follow-up. Hearing levels in both groups deteriorated in parallel as time progressed but tinnitus became less noticeable. Nineteen per cent of the long-term review patients showed evidence of developing cochlear hydrops in the contralateral ear. Conservative surgical procedures should be employed whilst any useful hearing exists, though the emphasis remains on controlling vertigo. Saccus decompression, despite its controversial therapeutic basis, will remain the first-line surgical procedure for many otologists. However, in the fit young Meniere's cripple or saccus decompression failure with serviceable hearing, vestibular nerve section remains the treatment of choice.

The role of radiographs in the management of nasal fractures is assessed. The inj ury is common and the total cost of radiographs significant. A retrospective study concluded that radiographs were not definitive in the management of nasal fractures. This prompted a prospective study, in which 54 patients were assessed clinically, radiologically and under anaesthesia. At each stage they were grouped into treatment and pathological categories and the contribution of each type of assessment studied. Radiographs were not found to be useful in the routine management of nasal fractures.

A study of skeletal lesions in the head and neck region of 20 adult patients with von Recklinghausen's disease, seen in the Surgical Out Patient clinic of Lagos University Teaching Hospital from 1979 to 1985, has been carried out. Among the 20 patients, 13 (65 per cent) had symptoms related to the head and neck while 7 (37 per cent) did not; however, on radiological screening, all of them were observed to have skeletal lesions. The commonest feature was enlarged intervertebral nerve root exit foramina from mesodermal dysplasia, which occurred in 16 (80 per cent) of our patients. Other major findings were erosion of the mandible, 8 (40 per cent); erosion of the wings of the sphenoid, 4 (20 per cent); poor mastoid bone pneu-matisation, 3 (15 per cent); erosion of the parietal bone, 3 (15 per cent) and heterotopic bone formation, 1 (5 per cent). Congenital calvarial defects were not detected. In view of the fact that all our patients showed radiologically detectable skeletal lesions of the head and neck, despite absence of symptoms in 35 per cent, it is advisable that all patients with von Recklinghausen's disease should routinely have radiological screening of this region, to detect early lesions.

Neurinomas originating from the ninth cranial nerve are rarely boserved. The early signs and symptoms of a glossopharyngeal neurinoma are rather discrete, and it can happen that a tunour here will often first be recognisd with the signs and symptoms of an expanding posterior fossa lesion—thus often closely resembling an aconstics neurinoma.

The authors have treated a 61-year-old woman with neurilemmoma of the larynx. The tumour was located in the submucosal region of the arytenoid on the right side of the larynx. Surgical resection of the tumour had to be done by external neck excision instead of endoscopically.