Viable and non-viable B. catarrhalis were mixed together with S. pneumoniae and H. influenzae and injected into non-bacterial mucoid effusion material collected from the middle ear of patients with a present secretory otitis media. The samples were incubated at 37°C. Presence of viable B. catarrhalis could evidently prolong the survival of both S. pneumoniae and H. influenzae. Presence of non-viable B. catarrhalis could also enhance the growth of S. pneumoniae, but not H. influenzae. In contrast both S. pneumoniae and H. influenzae suppressed the growth of B. catarrhalis.

The number of operations for cholesteatoma, together with the number of cases undergoing insertion of ventilation tubes in the Tayside region of Scotland between 1966 and 1986 have been studied. During this period there has been a sixty fold increase in the use of ventilation tubes, but the incidence of cholesteatoma surgery has only varied between 0.94 and 1.88 operations per 10000 of population per year. The mean annual incidence of cholesteatoma during this period was 1.32 cases per 10 000 of population. The results indicate that there has been neither a rise nor a fall in the incidence of cholesteatoma in Tayside despite a considerable increase in the use of ventilation tubes.

The sex ratio (proportion of males) of offspring of otosclerotics is significantly and substantially below expectation. To account for this and other features of the condition, it has been suggested elsewhere that otosclerosis is subject to autosomal dominant transmission with intrauterine selection against male heterozygotes. To test this hypothesis, a search was made for published data on the sexes of sibs of otosclerotics. These sibs do not have an unusual sex ratio, thus casting doubt on the hypothesis. Accordingly it is suggested here that both the condition and the sex ratios are causally related to levels of steroid hormones.

Investigation into the underlying disease causing an aural polyp is often hampered when the polyp itself obscures the tympanic membrane. This retrospective analysis of 65 patients undergoing aural polypectomy was carried out to identify and predictive factors for underlying cholesteatoma and to determine a correct management stratergy for aural polyps. The duration of symptoms, size of polyp, size of conductive component of hearing loss and bacteriology of otorrhoea were unhelpful as predictors of the underlying disease. Radiological evidence of bony erosion of the mastoid is a useful sign of cholesteatoma when present.

Aural polypectomy resulted in 58.3 per cent of ears becoming inactive. It is proposed that aural polypectomy and histological assessment should be employed as initial treatment with mastoid exploration reserved for those ears thus identified as high risk for cholesteatoma.

In a series of 100 patients with unilateral acoustic neuroma the incidence of mastoid aching was found to be 25 per cent, though none of the patients reported this as their principal symptom. Mastoid ache was not related to tumour size, hydrocephalus, or duration of symptoms. However, there was a significantly higher incidence of facial numbness and diminished facial sensation, but not facial weakness, compared with the whole series. Since motor fibres are more resistant to pressure than sensory fibres, mastoid ache may signify the pressure of an expanding cerebellopontine angle tumour.

The House and Brackmann grading system has been recommended as a universal standard for assessing the degree of facial palsy. This study examined the inter-observer reliability of this system. Three observers assigned a grade to each patient, examined independently, on the same day. Forty patients with a unilateral facial palsy of varying aetiology and severity were assessed. Of the 120 judgements, eight were in dispute, by a maximum of one grade, giving an inter-observer reliability of 93 per cent.

We conclude that the House and Brackmann grading system is a simple and robust method of assessing facial function.

Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.

Abstract Adenocarcinoma of the ethmoid sinus is a rare cancer in this country but relatively common in High Wycombe because of the concentration of furniture factories in this area. The management of five cases occurring recently in the High Wycombe area is described and changes in management since 1960 discussed.

A large number of non-human mammalian larynges have been studied in an attempt to relate body mass to maximum glottic and tracheal area in order to confirm symmorphism.

Where elective surgery carries a risk of damage to the recurrent laryngeal nerve, pre-operative examination of the larynx is routine. The incidence of positive findings at such examination has been determined by retrospective review of 1,947 clinic records. Only 31 vocal cord palsies were found. The possible causes and relevance of such findings are discussed.

Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the presence of copious mucopurulent secretions in the trachea. It is an uncommon condition that requires prompt diagnosis and intensive medical therapy if significant morbidity and mortality are to be avoided.

Since the condition was first described in 1979 approximately one hundred cases have been reported. In this paper we present four children with bacterial tracheitis to add to the current literature. Interestingly, one child was admitted on two separate occasions with the disease, an event not previously recorded. All patients underwent endoscopy which revealed findings typical of bacterial tracheitis in each case. None required tracheostomy though three required nasotracheal intubation. Post-endoscopy all were managed in the Intensive Care Unit. There were no fatalities or significant morbidity. The average duration of hospitalization was seven days.

Antibodies to specific human immunodeficiency virus (HIV) polypeptides are important laboratory markers of HIV infection. We have used an antibody to the major structural gag protein p24 of HIV-1 virus to immunochemically localize this capsid antigen in lymphoid cells from seven of eight patients at risk for HIV infection and who presented with parotid lymphadenopathy and lymphoepithelial cysts of the parotid gland. A clinicopathological assessment of these two manifestations as they relate to HIV infection is also presented.

Following surgical trimming of the inferior turbinates, 32 nostrils were packed with Calcium alginate fibre (Kaltostat 2 gramme fibre packs 80:20 per cent calcium:sodium) for 36–48 hours to achieve haemostasis. There was no bleeding while the packs were in place or after they were removed. These results were compared with two retrospective groups of patients who had undergone the same surgical procedure but the nostrils had been packed with alternative materials.

Congenital cholesteatoma usually presents as either a conductive deafness or as a facial palsy. We report a case which presented as a post-auricular mass. It is important to recognize the possibility that the disease may present in this way when considering the management of such a mass.

Two case reports of HIV positive patients presenting with sudden sensorineural hearing loss are described. The importance of CT scanning and cerebrospinal fluid examination are stressed. The possible aetiology and pathology of the condition are also discussed.

An unusual case of a patient presenting with left sided pulsatile tinnitus is presented. This was later shown to be due to a dural arteriovenous malformation involving the lateral venous sinus. The diagnosis was suspected by the presence of a bruit over the mastoid process and confirmed by a CT scan and angiography. Management involved pre-operative embolisation and neurosurgical excision. The differential diagnosis of pulsatile tinnitus and the management of a dural arterio venous malformation is discussed.

Malignant Fibrous Histiocytomas (MFH) are uncommon in the head and neck and extremely rare in the nasopharynx. We report a case of MFH arising in the nasopharynx and describe its diagnosis and management. The literature is reviewed and the likely origins of the tumour and its behaviour are discussed.