The relationship between diabetes and senbsorineural hearing loss has been disputed. This study compares 44 insulin-dependent diabetics with 38 age and sex matched controls. All had pure tone and speech audiometry performed, with any diabetics showing sensorineural deafness undergoing stapedial reflecx decat tests. In 14 diabetics stapedial reflex tests showed no tone decay in any patient, but seven showed evidence of recruitment. Analysis of vaiance showed the diabetics to be significantly deafer than the control population.The hearing loss affected high frequencies in both sexes, but also low frequencies in the male. Speech discrimination scores showed no differences. Further analysis by sex showed the males to account for most of the differences. Analysys of the audiograms showered mostly a high tone loss. Finally duration of disbetes, insulin dosage and family history of diabtes were not found to have a significant effect on threshold.

Severe radionecrosis of the temporal bone is a potentially lethal condition which still occurs despite improvements in radiotherapy.

A Series of seven such cases is presented to outline the varied clinical features and management of this disease.

This prospective randomized study investigates whether the use of antibiotic/steroid ear drops (Betnesol-N) is effective in reducing early post-operative otorrhoea and blockjage of ventilation tubes (VTs). The study included 162 children who had bilateral VT insertion and used Betnesol-N ear drops in one ear only for three days after surgery, the other ear was left as cotrol. These children were reviewed two weeks later and their ears wer examined for VT patency, presence of blood or of mucopus. Statistical analysis of our results showed that the use of Betneso-N ear drops has significantly reduced the incidence of post-operative otorrhoes within two weeks of VTs insertion (p<0.01). However, these drops dids not have a significant effect on the blockage rates of VTs with dried bolld (p>0.05).

Ever since Armstrong reintroduced the concept co grommeet insertion parents have been asking ‘may my child swim?’, yet there is still no consensus as to the correct answer. This paper reviews the work that has been done on this subject in the last 25 years. A review of teh reates of otorrhoea following grommet insertion, irrespective of swimming, shows a variation from 12 to 64 per cent. Evidence suggests that pressures of 12–23 cm H2O are needed to push water through a grommeet and that it is unlikely that water will enter the middle ear during surface swimming. Only bath water seems to cause significant inflammtory changes to middle ear mucosa. Not a single paper comparing swimming without ear protection can be safely permitted for children with grommets.

Patients anticoagulated with warfarin form a small proportion of thos se admitted with epistaxis annually to ENT units. The authors formed the impression that such patients spend longer in hospital and have more complicated management than controls. A prospective age and sex matched controlled study of 20 consecutive patients admitted with epistaxis whilst anticoagulated was performed. This showed thath these patients spent significantly longer in hospital than cntrols, with an additional expense in the study periold of £10,500 for impatient bed nights alone. The management of these patients is more complicated and these is a subgroup of poorly controlled patients who present most of the problems. A potentioal solution is to improve community warfarin control and to involve general practitioners and haematologist in the re-establishment of warfarin following admission for epistaxis.

Inflatable balloon catheters are widely used in the treatment of severe epistaxis and are designed to be filled either with air or liquid. A postal survery revealed that 87 per cent of respondents used an inflantant which was deemed inappropriate by the manufacaturer. When ballons designed for water or saline were filled with air, they defalted rapidly, in some cases beings virtually empty after 24 hours. Better and more accessible instruction leaflets are required if the balloons are to be used as intended.

Foley catheters are frwquently used as nasopharyngeal packs, in conjunction with anterior nasal packs. Paraffin in the commonly used anterior packs damages the rubber of the catheter, resulting in the balolon bursting. This should be recognized by clinicans as a possible cause of rebleeding.

From April, 1986 to June 1989 49 Patients (29 male, 20 female) aged 20 to 70 years old whod developed carcinomea of naospharynx (included 15 with relapses) were trated with neoadjuvant regional chemothrapy, followed by radiotherapy, or crysurgery and radiotherapy.

Thirty-three of the patients had squamous cell carcinoma with poor differentiated, four with well differentiated squamous cell carcinoma were included. Tumours were treated with three moalities: (I) Induction regional chemotherapy with temporal aftery catheterization as well as superselective intra-arterial chemotherapy of the femoral artery (chemotherapeutic agents: pingyangmycinum (P), Cisplatin (D), Vomcromstine (V), Methotrexate (M) and P.D.M. programmes); (2)Liquid cryosurgery in 25 cases; (3) Radiotherapy was carried out for two weeks after crysosurgery after chemotherapy.

The date showed CR (complete response—all tumour gone) and PR (partial response—more than 50 percent reduction) in 40 cases (81.6 per cent) and NR (no response—less than 50 per cent or no response) in nine cases (18.3 per cent) following regional chemotherapy. All of the patients were followed up for more than one year, and 48 of them survived (97.9 per cent). Thirty-five cases were followed up over two years and 28 of them survived (80 per cent). Twenty cases were followed up over three years, and 12 of them survived (60 per cent).

The effect of regional chemotherapy and crysurgery in combined treatment for carcinoma of the nasopharynx is discussed in this paper.

The use of phlebotomy for a full blood count (FBC) and group and serum storage (G&S) prior to tonsillectomy with or without adenoidectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists within the South West Thames region. This was compared with ‘countrywide’ practice assessed by means of questions to attenders at an otolaryngology course.

A postal response rate of 86 per cent was obtained with 67 per cent within the region requesting a FBC prior to tonsillectomy and 50 per cent to adenoidectomy alone. This was much greater than for the ‘countrywide’ group with 24 per cent and 6 per cent respectively. Requests for pre-operative G&S were 17 per cent and 6 per cent respectively.

This large difference in practice suggests that in the clinically healthy patient with no specific indications, pre-operative haematological investigations may be non-contributary, which has important financial implications. The maintenance of post-operative intravenous access is considered to be much safer, less traumatic and cheaper.

Palatal myoclonus is a rare syndrome characterized by involuntary rhythmical movements of the soft palate giving rise to clicking objective tinnitus. The intrusive nature of the tinnitus prompts patients to seek medical advice but to date no single treatment modality has been shown to be consistently effective. We present three cases in whom various management regimes were unsuccessful and in whom botulinum toxin injection to the palatal muscles was undertaken. All three cases were rendered free of their tinnitus with complete abolition of the myoclonus. The questions of optimum dosage as well as frequency of injection will be answered as greater numbers are treated by this method.

After a median follow-up of 12 years, median overall survival of 73 patients with advanced squamous cell carcinoma of the larynx was 65 months. The 61 per cent of patients responding to two courses of initial schedule A combination chemotherapy, not including cisplatin, and the 81 per cent of patients achieving a final complete remission after definitive local therapy, had median overall survival figures of 95 and 97 months respectively. Overall survival and relapse-free survival in 51 patients treated with radiotherapy only with larynx preservation, were not significantly different from the 21 patients who completed their surgery with pre- or postoperative radiotherapy: median overall figures were 71 versus 65 months. These data add weight to our proposal that use of initial combination chemotherapy followed by radiotherapy may eliminate the need for radical surgery, so preserving the larynx in patients with advanced disease, and provides evidence of some long-term benefit with 32 per cent of this entire group surviving 12 years.

Over a five-year period during which 99 children underwent successful ward decannulation, 14 other children were deemed unsuitable and underwent surgical decannulation. The technique of surgical decannulation involves excision of the tracheostomy tract with any granuloma and splinting of the anterior tracheal wall by the use of an indwelling nasotracheal tube for 48 hours post-operatively. It is indicated in carefully selected patients whose tracheostomies are complicated by large suprastomal granulomas, anterior tracheal wall collapse or previous anterior rib graft collapse into the airway. Nine of the 14 decannulations were successful. Success is dependent upon accurate prior endoscopic assessment and satisfactory previous reconstruction surgery in cases of subglottic stenosis. The five failures (4.42 per cent of all decannulations) represent some of the most demanding airway problems encountered.

The affect of radiotherapy on oropharyngeal bacterial flora was studied in the hope that this might help in controlling post-operative infections in previously irradiated patients. Eighty patients were included from whom swabs were taken before and at the end of irradiation, Swabs were also taken two weeks after treatment in the last 40 patients. Thirty healthy controls were included.

It was found that coagulase positive Staphylococcus aureus, β-haemolytic streptococci, Candida albicans, B. proteus, and Pseudomonas aeruginosa, were significantly increased at the end of irradiation, while Klebsiella was increased significantly in the period after irradiation. Culture and sensitivity was performed for the organisms isolated in the last 40 patients.

From this study it is evident that irradiation has a significant effect on oropharyngeal flora.

A rare case of paraganglioma of the external auditory canal is presented. It was treated by excision and no recurrence has been noted after 18 months of follow up.

Progressive sensorineural hearing loss is the most important early symptom of a cerebellopontine angle process. A case report is presented of a 42-year-old woman who was referred to our department in 1979. Oil cistemography showed non filling of the left internal acoustic canal. Audiometry was planned as the method of control, but she did not return until nine- years later. In 1988, an acoustic neurionoma of 4 cm diameter was found in the left CPA. Pure tone audiometry and speech audiometry showed that during the nine-year interval, her 60 dB flat sensorineural hearing loss and speech perception thresholds had remained almost unchanged. A follow-up with only tone and speech audiometry can lead to a false negative diagnosis in some of these cases. Calculation of the growth in tumour volume over nine years in this patient showed a tumour volume doubling time of about 15 months.

An 18-year-old woman with insulin-dependent diabetes mellitus developed an infection of the paranasal sinuses with Rhizopus oryzae resulting in facial swelling, hemiplegia and blindness of the right eye. The therapy of this rhinocerebral mucormycosis consisted of extensive surgical debridement, administration of high-dose amphotericin B, hyperbaric oxygen and control of the underlying predisposing diabetes mellitus. The patient eventually recovered with however, the loss of one eye.

Glomus tympanicum tumours are highly vascular tumours of the middle ear. Their removal by conventional surgical methods requires an extensive procedure in many cases, often with ossicular disarticulation to allow adequate exposure prior to the ‘chaotic’ and haemorrhagic event of tumour removal. This paper reports on the use of an NdYAG laser in a case of a large glomus tympanicum tumour. The laser facilitated a transcanal approach, avoided ossicular disarticulation and allowed accurate and almost bloodless ablation of the entire tumour.

The NdYAG laser appears to be a very useful treatment modality in the management of these highly vascular tumours. Care should be taken to avoid accidental energy transmission to the cochlea.

A rare finding of a fourth branchial arch anomaly discovered at laryngectomy is presented. Clinical and histological findings are documented. The incidence and presentation of fourth branchial arch anomalies is discussed.

Although intrusions of glass fragments into the frontal sinuses are not uncommon in traffic accidents, a case with a tooth in the frontal sinus has never been reported. We report a patient with traumatic inclusion of an incisor tooth in the contralateral frontal sinus. Radiographic investigations demonstrated the tooth in the frontal sinus though no skin damage was recognized on the upper face. The usefulness of CT scan in localizing the missing tooth after facial trauma and its route of entry into the contralateral frontal sinus is discussed.

Two cases of osteomyelitis of the cervical spine complicating tracheo-oesophageal puncture are reported. There was considerable delay between onset of symptoms and diagnosis in both cases due to pre-existing cervical arthritis. Previous radiotherapy was felt to be a contributory factor in both cases.

Eight cases of cystic neck lesion of differing causes in whom sonography was carried out as part of investigation are described. These are thyroid cyst with haemorrhage, thyroglossal cyst, branchial cyst, cystic hygroma, parotid abscess of the neck secondary to malignant external otitis, cystic degeneration of a recurrent malignancy in the neck, sebaceous cyst and a cold abscess. They showed that sonography is better than clinical judgement in obtaining a diagnosis. Therefore, we recommend that ultrasound should be performed in all neck lesions prior to needle aspiration or open excisional biopsy.