Over a six month period, 709 children admitted for routine ENT operations were surveyed with regard to the presence of a bifid uvula as seen whilst under a general anaesthetic. The prevalence was found to be 7.5 per cent (53:709) which is higher than other published figures for a Caucasian population. There was a statistically significant male predominance (2.5:1). Comparision between those children found to have otitis media with effusion at operation and those having dry myringotomies, or operations not including myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis that bifid uvula as a microform of cleft palate is associated with an increased incidence of otitis media with effusion.

A study was undertaken to evaluate the prevalence and antibiotic susceptibility of bacteria present in the middle ear of patients with otitis media with effusion. Middle ear effusions (MEE), nasopharyngeal and throat swabs were obtained at operation and cultured for aerobic and anaerobic bacteria. Two hundred and fifty-nine effusions were obtained from 152 subjects examined. Haemophilus influenzae was isolated from 32 (12.3 per cent) effusions. Streptococcus pneumoniae from seven (2.7 per cent), Staphylococcus aureus from seven (2.7 per cent), Branhamella catarrhalis from one (0.4 per cent)—Group A β haemolytic streptococci from one (0.4 per cent) and Staphylcoccus epidermidis from three (1.9 per cent). The occurrence of respiratory pathogens in MEE reflected their prevalence in the upper respiratory tract. Significantly fewer children who had received antibiotics prior to surgery had organisms present in the MEE. Eight and a half per cent of H. influenzae and 64 per cent of B. catarrhalis were resistant to ampicillin. The present study confirms that bacteria are present in the middle ear in a significant number of patients with otitis media with effusion.

Middle-ear effusion in children is considered to be the result of multiple factors. Swimming in chlorinated water has been incriminated as one such possible aetiological factor. To test the hypothesis that the chemical disinfectant in the swimming pool is probably responsible for the Eustachian tube dysfunction, 30 children between the ages of four and eight years were selected at random from the community health department computer records and were randomly allocated into two groups. Eustachian tube function was assessed by standard tympanometry both immediately prior to swimming (control) and 30 to 45 minutes following swimming in Group 1 and approximately 14 hours following swimming in Group 2. The results of the study showed no significant change (p>0.05) between pre- and post-swimming tympanometry. It is therefore concluded that swimming on the surface of chlorinated water does not compromise the Eustachian tube function in children with healthy middle ears.

The past history of, and current trend in, stapes surgery are reviewed, and experience from a personal series of 128 procedures over an 18 year period is presented. Results are frequently poorer than many surgeons and their patients anticipate, and more stringent pre-operative case selection and centralisation of surgical activity would appear desirable. Amplification has become a more acceptable management alternative for some patient categories.

Unilateral vestibular nerve section (VNS) creates a state of acute dysequlibrium which resolves by a process of central compensation. This disturbance resolves quickly and central compensation is complete generally within a month with resolution of symptoms and signs. The course of central compensation following VNS will be similar to that seen after labyrinthectomy because the detachment of hemi-labyrinthine input that is achieved by both will be identical. Six patients are presented who have undergone VNS at least 2.7 years ago (Average 3.5 years); all of them have persisting spontaneous peripheral type horizontal jerk nystagmus, present with optic fixation in five. This is obvious clinically and was confirmed in each case by agreement of three independent observers and has been recorded by electronystagmography (ENG). They are free from marked vestibular symptoms. The explanations of mechanisms involved in central compensation are discussed with respect to this previously unrecorded clinical observation.

Questionnaires have been sent to all ENT Consultants practising in the UK in an attempt to establish current practice with regard to out-patient examination of the upper aerodigestive tract. Seventy-eight per cent of these were returned completed. The results indicate that mirror examination remains the most widely used method, though the fibreoptic rhinolaryngoscope and/or the Hopkins rod telescope are now used by many specialists. Mirrors are most frequently warmed by a spirit lamp, despite the fact that 125 respondents reported having had a fire in their departments. Other methods of warming mirrors are discussed.

The role of the anterior ethmoids in the pathogenesis of chronic maxillary sinusitis is still a subject of controversy. Although the symptoms of maxillary sinusitis may be clinically dominant, many previous studies have showed that the origin of this disease was, in most cases, located within the anterior ethmoid region.

This study included 100 Egyptian patients, suffering from chronic maxillary sinusitis (confirmed by maxillary sinoscopy), who were subjected to ‘systematic nasal endoscopy’. It was found that all cases of chronic maxillary sinusitis were associated with anatomical variations and/or pathological abnormalities of ‘the ostiomeatal area’. It is recommended, therefore, that during the diagnosis and treatment of chronic maxillary sinusitis, attention should be given to the region of the middle meatus and anterior ethmoid complex (or ‘ostiomeatal area’) for any anatomical variations and/or pathological abnormalities in order to avoid recurrence of maxillary sinusitis. This is the basis of the procedure of functional endoscopic sinus surgery.

Puncture and lavage of the maxillary sinuses is a common procedure in ENT practice. Repeated irrigations are required in chronic sinusitis refractory to treatment. In our department we use a No. 14 gauge Braunula® for such cases. Over 100 patients have been treated over the past two years with no significant complications. This device is inexpensive, sterile, safe and easy to use and we recommend its use for patients with chronic maxillary sinusitis requiring repeated irrigations.

The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were liagnosed. In each case long term topical steriod sprays had been prescribed and the patients had been eferred for further management of their ‘rhinitis’. Spontaneous CSF rhinorrhoea is potentially life hreatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the istula is employed.

Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.

Children presenting with ethmoidal mucocoeles are rare. Five children are presented with such findings, and the diagnosis, treatment and possible aetiology discussed.

C. T. scanning was found to be the investigation of choice, while plain sinus X-rays correlated poorly with the presence of disease. Exenteration through an external approach was found to be satisfactory. In two cases drainage obstruction due to congenital abnormality was thought to be the underlying cause, while in four cases there was a strong history of atopy, indicating allergy as a possible reason for mucocoele formation.

Facial skeletal morphology was studied by cephalometric analysis in 25 patients with obstructive sleep apnoea syndrome (OSAS) and ten controls. The hyoid bone was more inferiorly positioned in patients (at the level of cervical vertebrae C4-C6) than in controls (C3-C4 level). The height and length of the nasal cavity was normal, while the length of the bony nasopharynx was moderately reduced. The mandibular plane inclination was slightly larger in patients as was the anterior face height. Mandibular retrognathia was demonstrated in six patients (24 per cent), but the angles of maxillary and mandibular prognathism was within normal limits when the group was considered as a unity. Cephalometric analysis is highly recommended as a diagnostic aid in OSAS patients, especially when surgical intervention is considered.

Oropharyngeal reconstruction especially after surgery for medially located lesions of moderate dimensions presents a challenge. The risk of using well vascularized, but insensitive tissues close to the airway has led to the development of several measures to overcome the difficulties involved. The transposition of masseter muscle which has been put forward in recent years provides successful primary closure with preservation of function.

Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty.

SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure.

Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.

The number of elderly patients requiring oncologic head and neck surgery is increasing as this proportion of the population continues to grow. To establish the specific problems and relative risks, 100 patients, 70 years of age and over have been examined to determine post-operative mortality and morbidity. Results do not show these to be significantly increased in the elderly and support an aggressive approach to head and neck cancer management in these patients.

From 1968 to 1987, mediastinoscopy was performed on 2021 consecutive patients. The procedure was carried out in 35.7 per cent on patients with a pulmonary infiltrate and in 28.8 per cent with bronchogenic carcinoma. Mediastinoscopy was positive in 54 per cent of the cases. The total number of complications was 2.3 per cent (47/2021). There were four cases with major haemorrhage, three tracheal ruptures and three wound infections. Recurrent nerve paralysis was verified in three patients and pericardial rupture in two patients. The total of major complications was 0.5 per cent (10/2021). There was no deaths in this series. In the authors' opinion, mediastinoscopy can be regarded as an effective and safe procedure in the hands of an experienced surgeon.

A case of superficial epithelioid schwannoma is presented. The lesion arose as a skin papule in the infra-orbital region and recurring repeatedly over a five-year period, caused significant local morbidity without metastasis. Radical surgery was delayed in the hope of preserving binocular vision. The similarity of this tumour with a rare variant of malignant melanoma, the neurotropic melanoma, is discussed.

Septic arthritis of the temporomandibular joint is an uncommon condition. As a complication of otitis externa it is extremely rare. Two cases are reported and the aetiology, diagnosis and management discussed.