The study was carried out in children born during the four year period 1981–1984 in the Greater Manchester County. The children were investigated for possible congenital infections. Perinatal assessment was carried out for adverse aetiological factors. Family histories were obtained and parents and siblings were examined for any hearing impairment. A total of 164 cases were investigated. Various aetiological groups were formed which showed the following distribution: cause unknown 36.5 per cent; genetic group 20.1 per cent; adverse perinatal factors 14.6 per cent; congenital infections 9.8 per cent; meningitis 6.1 per cent; chromosomal abnormalities 3.7 per cent; syndromal group 3.7 per cent; and miscellaneous 5.5 per cent. The findings are discussed in the light of previous studies.

Brainstem Evoked Responses have been used in the Audiology Unit in Crosshouse Hospital since it opened in 1984, and have now come to form a vital asset in our assessment and diagnosis of the hearing threshold in children. This particular survey is a retrospective study of the BERA used in determining the hearing threshold in children. The survey has been limited to the BERA performed on children from January, 1985 until December, 1986.

Tympanometry and acoustic reflex tests performed on 431 school children aged five to six years showed that eight per cent of the ears screened had type B or type C tympanograms suggestive of otitis media with effusion (1.2 per cent type B, and 6.8 per cent type C). Preliminary otoscopy revealed tympanic membrane appearances consistant with middle ear effusion in a correspondingly low proportion of ears (7.6 per cent), whilst acoustic reflex screening at 105 dB for three frequencies (0.5, 1 and 2 kHz) showed absent reflexes at one or more frequencies in 8.1 per cent of the ears. The findings indicate a relatively low prevalence of otitis media with effusion in children in Nigeria. Possible contributory factors are discussed.

To determine which factors were associated recurrence of ottitis media with effusion following grommet insertion, the casenotes of 323 who had a total of 485 operations for grommet insertion were reviewed. The incidence of repeat surgery was higher in those aged between four and six years, in those having grommet insertion between the months of July and October and in those cases in which the grommet was extruded within six months. Recurrence was not related to sex of patient, month of listing for surgery, adenoidectomy, tonsillectomy, length of time on the waiting list or past history of previous grommet insertion.

A study was conducted on seventy children to ascertain any relationship between parental smoking and the presence of middle ear effusions in the children.

Information was collected using a questionnaire, clinical examination and audiological tests. Both groups of children (with and without effusions) has similar age, sex and social class distributions.

It was found that the presence of middle ear effusions in the children was associated with an increased incidence of parental smoking. Those children with an abnormal tympanometry result were more likely to have at least one parent who smoked than those with normal tympanometry results. There was no relationship between resolution of the effusion and parental smoking.

It is therefore suggested that as part of the management of this condition parents should be advised of the effects of smoking on the condition and encouraged to avoid smoking in the same environment as their children.

A retrospective review of 64 Goode ‘T’ tube insertions is presented. These were inserted into 61 ears of 48 patients over a period of four years. At the time of review of these 61 ears, 34 tubes were found to be in situ, 27 had extruded spontaneously and three had been removed surgically. Ten ears in which the tube had been extruded or removed had central perforations of the tympanic membrane of which eight had been present for more than six months. The number of previous myringotomies or grommet insertions did not increase the likelihood of developing a perforation. Tympanostomy tubes of this type should not be used indiscriminately.

Cholesteatoma in children may be a sequel to chronic exudative otitis media with tympanic membrane retraction but he the role of grommets in the possible facilitation of squamous epithelial invasion into the middle ear is not yet clear. A retrospective study was made of the history and prior treatment in 25 children who underwent mastoidectomy for cholesteatoma at St. Mary's Hospital between 1975 and 1986. Thirteen patients had undergone previous middle ear aeration procedures which included myringotomy, cortical mastoidectomy and grommets. There was no difference in the site or severity of cholesteatoma in the operated and non-operated cases. Of the seven patients with a history of multiple grommets three had primarily attic, and three had primarily mesotympanic disease. The latter had greater ossicular erosion. One patient with an intact tympanic membrane had grommet insertion subsequently developed a cholesteatoma. While cholesteatoma due directly to the presence of grommets is rare, it appears that children who require multiple grommet insertions constitute a high risk group and should be very closely monitored.

Of 325 previously untreated cholesteatomas, 109 were found to be in children 13 years old and younger—however, these 109 ears were not found to consist of one clinical entity. Sixty-three of the 109 ears presented a marginal perforation or a retraction pocket, at the level of Shrapnell's membrane or beyond the posterosuperior quadrant. In this group the cholesteatoma was distributed mainly in the attic and mastoid and was associated with a non-cellular mastoid. A second group comprising 31 ears presented with cholesteatoma behind an intact drum and were considered to be primary cholesteatomas. These were distributed mostly in the tympanic cavity as cystic epidermoid formations—their mastoid was usually pneumatized. Eight cholesteatomas were related to a central perforation. These ears presented features very similar to the primary cholesteatomas i.e., a pneumatized mastoid and tympanic cavity distribution. The similar features of this group make us think that they may have also originated as primary cholesteatomas which eventually perforated and bring the percentage of primary cholesteatomas in children to 38.3%. Seven of the 109 ears with cholesteatoma were of an indeterminate character.

Epithelial salivary gland tumours presenting in the first month of life (perinatal tumours) are exclusively of major salivary gland origin and predominantly of the parotid gland. Approximately 25 per cent of these rare tumors have been histologically and/or biologically malignant. Except for an occasional pleomorphic and monomorphic adenoma, the majority of the tumors are proliferations suggesting a tumorous arrest of maturation of the salivary gland anlage, hence their designation as embryomas. A case report of an embryoma of the parotid is presented, accompanied by a review of the literature.

A review was performed of the treatment of 92 patients with acute epiglottitis with special reference to the different procedures employed in children and adults. Intubation was performed in 74 per cent of the children but in only six per cent of the adults. More than half of the children were initially observed only, but of these 58 per cent eventually needed intubation. No deaths occurred. We present our management protocol as well as a survey of the routine management of acute epiglottitis in children in the five Scandinavian countries. The number of initially observed patients ranged from nil per cent in Iceland to 35 per cent in Finland. When an artifical airway is needed, 92–100 per cent of the patients are intubated, 0-8 per cent tracheostomized, and 0-5 per cent one or the other, as a standard procedure. Tracheostomy is performed in departments where the facilities do not permit sufficient observation of patients treated by intubation.

Acute epiglottitis in adults is a potentially fatal but self-limiting disease of increasing incidence world-wide.

Forty-two patients, seen consecutively over a four year period at the ENT Department, Singapore General Hospital were reviewed retrospectively.

A strong male predominance with a peak age incidence in the sixth decade was noted. A severe sore throat and dysphagia with disproportionate signs of oropharyngeal inflammation was the main presenting picture. Only three patients had stridor on presentation. Vigilant monitoring of the airway with empirical high-dosh intravenous amicillin, cloxacillin and steroids resulted in a dramatic clinical improvement in most patients and none developed stridor after admission. The yield from throat swabs and blood cultures were low. Two patients developed complications, a Ludwigs angina and an epiglottic abscess. Recurrent epiglottistis was a problem in one patient.

There was low morbidity and no mortality on the management regime outlined.

Sixty cases of recurrent respiratory papillomatosis in both children and adults treated over a 10 year period were reviewed. An unexpected finding was that nine of the 60 patients (15 per cent) had symptoms by two months of age; an earlier onset than previously described. The control rate was 66 per cent for paediatric onset patients and 44 per cent with adult onset; the former required more operations. No anaesthetic deaths or complications were encountered. Glottic webs were the only surgical complication. The findings confirm that there is no relationship between puberty and the rate of control of recurrence. The necessity for precise and comprehensive endoscopic examination of the upper aerodigestive tract using a range of endoscopes and rigid telescopes under general anaesthetic is emphasized.

Inhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyze the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and fort eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.

Teratomas are congenital tumours arising from pluripotent cells and usually consisting of tissue arising from all 3 embryonic germ layers. Teratomas are quite uncommon in head and neck sites and to date only 150 such cases have been reported. A rate case of teratoma of the mastoid region in a newborn is reported. The methods of diagnosis and treatment are discussed and the literature is reviewed.

There is argument about whether, whilst swimming, water should be excluded from ears which have middle ear ventilation tubes in place in the tympanic membrane.

The adhesive putty substance BLU-TACK (registered Trade Mark, Bostik Ltd, Leicester, England LE4 6BW) has been suggested as an effective ear plug for this purpose.

A case is described in which an alternative adhesive putty substance was used as a waterproof plug. The result was that the plug became semi-solid and impossible to remove without the use of micro instruments and removal would have required general anæstgetic in a less co-operative patient.

Patients should be warned of this risk.

Three rare cases of congenital anomalies (mid-line nasal proboscis, subintegumental mid-line cleft lip and congenital palatoglossal synechia) are presented with their management. The embryological considerations of these cases are discussed.

A case of Osteopertrosis (Marble Bone Disease) in a child is presented. Agenesis (non-pneumatization) of all paranasal sinuses has been one of the salient features in this case.