The long-term results of 925 stapedectomies were analysed after a mean follow-up period of 15 years. Patients who had the operation before the age of 30 were analysed separately. The entire group deteriorated by an average of 0.91 dB/year at 500–2000 Hz, while the under-30 group deteriorated by 0.67 dB/year. There were but slight differences in the conductive component, considering frequencies and age. The perceptive loss'year was not far from that in a normal population.

In 54 ears lacking the stapedial arch and the long process of the incus, ossiculoplasty was performed with a shaped auto-or homologous incus as columella. In 29 of the ears, the deep, slender part of the columella was coated with a silastic tube in order to prevent adhesions and dislocation. One year after the operation the functional results were similar in patients with silastic coating of the incus to those without. It is concluded that the less satisfactory results of tympanoplasty in such ears are primarily caused by factors outside the niche of the oval window. Possible ways of improving the results are discussed.

The anatomy and physiology of the middle ear transformer mechanism in man and a species of rodent, desmodillus auricularis, are compared. This rodent's middle ear mechanism has a transformer ratio of 147: 1 as compared to 18, 3:1 in man—some 8 times greater. The reasons for this difference are given and possible applications to middle ear surgery are suggested.

Documentation of normal and pathological anatomy is important to all medical practitioners. The ability to visualize and photograph the upper respiratory tract has been revolutionized by the advent of the flexible fibreoptic rhinolaryngoscope (FFRL), which demonstrates a one-instrument capability for the examination and photodocumentation of the ears, nasal cavity, nasopharynx, larynx, hypopharynx and trachea (Selkin, 1984). If a large natural maxillary ostium, or surgical window, is present, the antrum may also be examined.

The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech.

Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion.

Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood.

Twenty-one total pharyngo-laryngectomies have been performed at the Manchester Royal Infirmary between 1968 and 1982. A variety of methods of repair have been used, gastric transposition being the most common. Seventeen patients had received previous radiotherapy to the area, fourteen radical, two palliative and one to a supraglottic carcinoma 12 years before. Four had tumours judged to be too large to benefit from radiotherapy.

Of the patients who received radiotherapy, fourteen had a good response with palliation for an average of ten months before symptoms began to return.

Four patients survived over five years post-operatively and ten died following surgery.

Forty four free vascularised tissue flaps have been used in the reconstruction of defects arising following the treatment of malignant disease of the head and neck in 42 patients over the period January 1983 to September 1984. The uses of free flaps and their advantages and disadvantages when compared with other methods of reconstruction are described.

Salivary duct carcinomas of the major salivary glands have two major distinguishing features. They closely resemble ductal carcinomas of the breast and they are high-grade malignancies. In general, but particularly for carcinomas measuring three or more centimeters in size, the clinical course is one characterized by a resistance to local control, metastases to regional lymph nodes and distant sites, and death within a few years after primary surgical treatment.

Otorhinolaryngological manifestations of 13 patients with von Recklinghausen's disease appearing at Lagos University Teaching Hospital over a five-year period have been studied. Among patients with ENT manifestations of the disease, the most common general features exhibited were cutaneous neurofibromas (100 per cent), headache (69.23 per cent) and pruritus (46.15 per cent). But the head and neck findings included external meatal canal stenosis (30.77 per cent), conductive deafness (30.77 per cent), nasal discharge (30.77 per cent), cranial nerve involvement (30.77 per cent) and disfigurement of the soft tissues of the face (30.77 per cent). Involvement of pinna (23.31 per cent), rhinolalia aperta (15.38 per cent), mental retardation (15.38 per cent) and pharyngeal swelling (7.69 per cent) also featured. Clinically detectable bilateral acoustic neurofibromas in adults or astrocytomas in children were not found in this series. Involvement of the frontoparietal bone (7.65 per cent) presented with skull bossing which had to be differentiated from that due to sickle cell disease in the African. There was also a singular case of phrenic nerve involvement. However, malignancy occurred in one (7.69 per cent) of these patients. Thus, it is important always to follow-up these patients closely so as to detect malignant transformation in time.