It seems reasonable to postulate that if a patient has a hearing impairment at particular frequencies, selective amplification at those frequencies would be an advantage. Attempts have been made in the laboratory to show that when this is done scores on various audiometric tasks will improve. Whether such laboratory benefit will be preferred by patients in their daily life is another matter. Despite a lack of knowledge on this subject, modifications are frequently made to a hearing aid system in the expectation that this will improve auditory performance and hence be preferred by the patient. The most common modifications made to an ear level aid in the British National Health Service are adjusting the tone control and venting the ear mould with the aim of emphasizing the higher frequencies.

A randomized crossover study was carried out in 83 first time hearing aid users with a mild to moderate hearing impairment to assess whether a hearing aid at the ‘H’ tone setting and with a 2 mm vented mould would be preferred by those with a more marked high frequency impairment. BE series aids were used so that any findings could be directly translated to NHS practice.

No consistent preference for the modified system was identified when patients were subgrouped according to the overall slope (0.5 to 4 kHz) of their audiogram. However, when the slope between 0.25 and 1 kHz, which corresponds to the real ear effect of these modifications, was analyzed patients with a slope at these frequencies preferred the high-tone emphasis system (p<0.005). A second but lesser predictor of preference was age, those under 66 years preferring a modified and those over 69 years preferring an unmodified system (p<0.05).

These findings need to be confirmed using different methods of altering the frequency response. What acoustical effect these achieve in a specific patient need to be confirmed using ‘in the ear’ measures before any preference they might have can be related to the configuration of their audiogram.

Eighty-three children between ages 0–12 years had mastoid surgery in the three year period 1986–88. The indications were acute mastoiditis (30 children), uncontrolled chronic suppurative otitis media (CSOM) (24 children), cholesteatoma (22 children) and a miscellaneous group (7 children). Forty-seven per cent of those with acute mastoiditis were under one year but the 27 per cent with cholesteatoma as the precipitating cause were 4–12 years. Twenty-three per cent had significant complications. Typmano-mastoid surgery was employed to resolve uncontrolled CSOM. Children were between 2–12 years and 62 per cent were below the 25th centile for weight. Seventy-nine per cent of the tympanic membrane grafts were successful. The children with cholesteatoma were between 3–12 years and 76 per cent were below the 25th centile for weight. Eight of them only presented after the onset of acute mastoiditis. One child had a definite congenital cholesteatoma. Only one had a pars flaccida origin of the cholesteatoma sac and only eight an origin from the postero-superior pars tensa. All had open cavity surgery. When the cavity was lined by temporalis fascia, healing was improved markedly.

Autologous cultured epithelial layers were established from biopsies from the mucosa of the cheek, a nonkeratinizing region of the oral cavity. These were grafted to the unepithelialized mastoid cavities of nine patients with chronic mastoiditis and severe otorrhoea varying from two to 30 years' duration. All procedures were performed on an out-patient basis, with no anaesthesia except for topical anaesthesia for the mucosal biopsy. In seven of the patients the grafts took well, with complete resolution of the otorrhoea for a minimum follow-up period of eight months. In one patient there was a partial take of the graft with substantial improvement in the rate of discharge. The mastoid cavities of two patients were biopsied five months after grafting, and demonstrated a stratified squamous epithelium, with keratinization of the epithelium clearly evident.

Obliteration of persistently discharging open mastoid cavities is one surgical option to achieve a dry ear. All the currently described techniques involve the use of random pattern local tissue flaps or free grafts. Ten patients have undergone obliteration procedures using the vascularized temporoparietal fascia flap. This resulted in rapid epithelialization by six weeks in seven out of 10 cases. The remaining three patients have persistent non healed areas over the medial attic wall, but are not troubled by otorrhoea. The indications, technique and complications of mastoid obliteration by this axial pattern flap are described.

Middle ear pressure and tympanic membrane compliance were measured in 34 infants and young children (66 ears) with normal middle ears under oral choral hydrate hypnosis. Tympanograms were performed before and 40 to 60 minutes after administration of the drug. Results showed that the middle ear pressure increased significantly in all cases and in both sexes. This increase ranged between +19 and +219 mm H2O. In all cases the pressure returned to its prehypnotic values after recovery. Results of tympanic membrane compliance showed significant increase in males and not significant decrease in females.

Results are reported of a study to evaluate possible associations between nasal septal deformity and palatal symmetry in neonates.

Five hundred babies, born consecutively, were examined within three days of birth. Prenatal and delivery data were recorded for each baby and the nose was examined to determine airway patency and possible septal deformity. When a deviation of the septum was discovered an alginate impression of the palate was taken along with photographs of the nostrils. A matched control was then selected for each study group baby and similar records were obtained.

Only 14 cases of septal deformity were found, an incidence of 2.8 per cent. No evidence of palatal asymmetry was found. The theory that moulding pressures during delivery may be a major cause of nasal septal deformity was not supported.

The findings of a preliminary, prospective evaluation of the role of endoscopy in the management of adult posterior epistaxis are presented.

A cohort of patients managed by the endoscopic technique was compared with a control group managed by the traditional methods of nasal packing or epistaxis balloons.

The endoscope allowed visualization and direct treatment of previously undiagnosed posterior bleeding points. Patients managed by the endoscopic technique had a significantly shorter duration of in patient stay than those managed by traditional methods.

Thirty-three cases of nasopharyngeal carcinoma are reported. This is the first report of this condition from Jordan. Age, sex, early presentation and metastases are discussed. Bimodal distribution of age showed two peaks between 16–20 and 41–45 years. The disease was more common in males. Lymph node enlargement was the most common presentation, and bone metastases were the most frequent.

The enlarged adenoid is a common disorder in children resulting in nasopharyngeal obstruction. Many authors suggest that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of obstructive sleep apnoea and/or cardiopulmonary syndrome.

This study comprised 30 children complaining of long-standing nasal obstruction due to enlarged adenoids. Adenoidectomy was performed and the arterial blood gases were measured before and one month after surgery. Twelve normal children were also included as controls. Statistical evaluation of the results showed that O2 saturation and arterial O2 tension (PaO2) were significantly low before the operation, and increased significantly after surgery. Arterial CO2 tension (PaCO2) was insignificantly low before operation, but decreased significantly after adenoidectomy. It was concluded that enlarged adenoid may be associated with ventilatory impairment which is reversible after adenoidectomy.

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal.

The isolation rate of H. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p<0.05), as was that of group A streptococci, 5.4 per cent versus16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies of B. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups.

The high tonsillar core recovery rates of H. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.

The occurrence of disease in the remaining tonsil after unilateral tonsillectomy à chaudin the treatment of peritonsillar abscess, was studied in 536 patients. No patient had a history of previous severe tonsillitis at the time of the unilateral tonsillectomy, 6.1 per cent of the patients were readmitted for surgery of the remaining tonsil during the follow-up period. Ninety-seven per cent of these patients were younger than 30 years of age. Previous investigations have shown increasing frequency by age of pharyngitis after bilateral tonsillectomy. We suggest bilateral tonsillectomy in all cases of patients younger than 30 years old who suffer from peritonsillar abscess irrespective of previous tonsillar disease. Patients older than 30 should be treated with unilateral ablation, unless there is a clear indication for bilateral tonsillectomy.

Twenty-one patients with non-Hodgkin's lymphoma involving the palatine tonsil were studied in an attempt to relate pathological data to clinical outcome. Eleven tumours were classified as low-grade and ten as high-grade on morphological criteria. The results of immunohistochemical investigations are presented; all tumours but one were of B-cell origin. None of the pathological factors studied were found to be useful prognostic indicators.

We present a six-year retrospective review of feeding pharyngostomies as performed in this department. The indications, technique and complications of this procedure are discussed.

Twelve patients with bilateral fixed vocal cords seeking decannulation of their tracheostomies were subjected to endoscopic correction of the compromised airway. They all had arytenoidectomy associated with posterior cordectomy whether as a primary or secondary stage procedure. Decannulation was achieved in all patients using the technique described.

Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.

Analysis of 3,445 cases of cancer of the larynx witha follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.

From 1974 to 1990, 31 patients underwent emergency laryngectomy for airway obstruction due to laryngeal carcinoma, in aneffort to avoid the complication of stomal recurrence. This group of patients had a greater proportion of multiregional tumours (35 per cent vs 13 per cent) than a comparison group of elective laryngectomies. In other respects the two groups were similar.

Early post-operative mortality (6.5 per cent vs 3 per cent), stomal recurrence rates (4.2 per cent vs 4.8 per cent) and survival (53 per cent vs 55 per cent) were not significantly different between the emergency laryngectomy group and the comparison group undergoing elective laryngectomy.

Seventy four out of 94 cases of bronchoscopy carriedout over a five year period are reviewed. The clinical history of choking followed by recurrent spasmodic cough were found to be the most important element in making the diagnosis and proceeding to diagnostic and therapeutic bronchoscopy. Radiology was inferior as a diagnostic aid although radioactive scanning may be helpful in difficult cases.

We reviewed our experiences with 20 patients with established facial palsy who had a total of 24 gold weights inserted. All patients had corneal symptoms: ulceration, exposure keratitis or discomfort abolished. Functional improvement i.e. reduction of lagophthalamos and restoration of the blink reflex was good in our opinion and that of the patients in all cases. Dissatisfaction with the cosmetic result was expressed by two patients due to the prominence of the weight under the thin eyelid skin. Three patients had to have the weight replaced because it was too light. Two patients had their weightsremoved because of recurrent eyelid infections. In two patients the weights were removed as they had migrated over the tarsal rim. In one of these patients the weight was replaced immediately in the appropriate position, in the other it was not replaced as dissatisfaction hadbeen expressed due to the bulky appearance of the weight under the eyelid skin.

A patient who developed bilateral tinnitus and symmetrical high frequency sensorineural hearing loss due to therapy with the anti-depressant Mianserin hydrochloride is presented together with a short review of available literature.