Fifty children with otitis media with effusion undergoing grommet insertion had into one ear a Minititanium grommet inserted and into the other ear a Mini-teflon grommet. Post-operative follow-up until after extrusion of the grommets demonstrated only a small difference between the extrusion times of the two grommets (a significant difference of 41 days) and no difference in the degree of tympanosclerosis seen with each grommet. We propose that the mass of a grommet appears to play less of a role than has previously been suggested in the pathogenesis of tympanosclerosis following grommet insertion and that duration of intubation may be the most significant factor.

Following laryngectomy patients are usually advised that swimming is no longer possible. Under supervised conditions and using a swimming aid, such as described, a laryngectomee may return to an activity previously considered unavailable, rehabilitation thus being more complete. However, for a laryngectomee to proceed a safe supervised environment is required, and the path to this goal is often long and arduous, but with persistent dedication the Laryngectomy Swimming Club may become a reality bringing rich reward.

Retraction pockets of the pars tensa in children can result in erosion of the ossicles leading to hearing loss and eventually cholesteatoma formation. Several different types of treatment for the more severe grades of retraction pocket have been described. The aim of this pilot study was to assess the outcome following simple excision and ventiolation tube insertion of grade II, III and IV retraction pockets of the pars tensa. The eardrums were grades according to Sadé's classification (1979).

There were seven grade II and four garade III ratractions. Ten eardrums healed completely in a mean time of 3.6 months (mean follow-up 16 months) and there was one residual perforation. Two retractions recurred and both of these were only grade I. Clinically, an improvement in hearing was reported in seven children (eight ears) and the average air conduction threshold gain for these patients was 16 dB. A larger prospective study is currently underway.

Thirty families in which there were 149 individuals affected by the Waardenburg syndrome (WS) were investigated for penetrance of hearing loss and pigmentary abnormalities. Twenty two families contained 89 individuals affected by WS Type II and eight families with 60 individuals affected by Type I. A bilateral symmetrical sensorineural hearing loss was found to be the most common type of hearing loss. The most frequent degree of hearing loss category was a hearing loss of > 100dB HL with no difference between syndrome types.

Although there was no significant difference in the frequency of pigmentation disorders between Type I and II, considering these abnormalities as a whole, heterochromia irides was more common in Type II than Type I and other pigmentation disorders were more frequent in Type I: 62 per cent of Type I patients had more than one pigmentary defect, but only 28 per cent of Type II. Pigmentary disturbances were not significantly more frequent in the hearing impaired group than in the normally hearing group in either Type I or II when taking into account the occurrence of only one pigmentation disorder. There was a significantly higher proportion of pigmentary defects in the hearing impaired group with Type I when only those having more than one pigmentary abnormality were compared: 93.3 per cent of Type I patients and 88.5 per cent of Type II patients with a profound hearing loss had pigmentary defects. The frequency of pigmentation disorders was not greater when the hearing loss was more severe in either type. Penetrance for hearing loss and pigmentary abnormalities showed marked intrafamilial and interfamilial variation.

The aim of this study was to compare the prevalence of the different types of eardrum pathology in a cohort of adults not previously treated by grommet insertion with corresponding findings obtained in a cohort previously treated with grommet insertion.

A cohort born in 1955 were invited to a screening examination including otomicroscopy. In the untreated cohort, retraction of Shrapnell's membrane was found in four per cent of the ears compared to 20 per cent in the cohort treated with grommets. Tensa pathology, including atrophy and myringosclerosis, was found in six per cent of the ears in the untreated cohort and in 17 per cent in the treated cohort. Normal eardrums were found in 91 per cent of the ears. Despite the increased awareness of secretory otitis, as well as the increased rate of surgical treatment, the prevalence of eardrum pathology seems to be increasing. The reasons for this are discussed.

A straight, vertical post-aural incision for the ‘Cochlear’ multichannel cochlear implants has been evaluated in 52 patients (20 adults and 32 children). Nineteen of the children were under three years of age and five of these were under two years of age.

The 7cm long incision is placed approximately 3 mm behind the post-auricular crease and runs from the tip of the mastoid to a point 3 cm above the superior attachment of the pinna. The incision heals within several days.

Because the incision is straight interruption of the blood supply to the flaps raised is the least possible. This also minimizes the possiblity of scalp necrosis and impaltn exrusion. The likelihood of infection is reduced by the small size of the incision, minimal soft tissue dissection and small amount of dead space. Rapid healing has occurred in all cases despite infection in one.

A cohort of 214 patients, who were operated on to insert implants in the mastoid process for the retention of bone-anchored hearing aids and auricular prostheses, was followed-up over a five-year period. About half the group were operated on using the conventional two-stage procedure allowing three to four months for osseointegration. In the second group (one-stage group) the skin penetrating coupling was connected at the time of the implant insertion. The success rate for stable implants was found to be the same in both groups. In the one-stage group four out of 161 implants inserted were lost and in the two stage group three out of 120. The cumulative success rate was also found to be the same. A ‘worst case’ table where patients lost to follow-up, patients who died during the study period, and patients who for some reason left the study is also included. The importance of this ‘worst case’ scenario when follow-up data are presented is discussed.

Research on the eustachian tube (ET) and related paratubal structures was carried out by serial section of the temporal bone-ET specimens. In the cadaveric studies, the mid-cartilaginous section of the ET presented a curved slit-like lumen. It is believed that this section functions principally as a valve mechanism and acts like an active sphincter of the ET. This report illustrates the dynamic movement of the valve section in a living ET which can be observed by using a superfine fibreoptic videomicroendoscope. Disorders of the open-close mechanism of the valve section in a diseased ET due to different aetiologies are also discussed. This study indicated that transtympanic ET microendoscopy had considerable potential for exploring fascinating new aspects of the physiology, pathophysiology and anatomy dynamics of the ET.

Thirty consecutive patients with permanent perforations of their tympanic membranes (TM) present from 2.5 to 50 years (mean 18.7 years) were admitted to a prospective study using two alternative methods of dressings for closure of the perforations. An adhesive-coated hydrocolloid material was compared with a conventional dressing of vaseline impregnated rice paper patch after de-epithelialization of the perforation border. Nine of the permanent TM perforations (30 per cent), five with the hydrocolloidal dressing and four with the rice paper patch had healed when followed-up after one year. The size of eight of the central perforations that had healed was equal to or less than 25 per cent of the TM. Also one perforation with a size of 65 per cent had healed. Seven perforations were located in the posterior part of the TM:Jour in the posterior-superior quadrant, one in the inferior quadrant, one had engulfed the posterior half of the TM and one included the anterior-inferior quadrant. Only two perforations out of 14, with a size of 25 per cent or less, located in the anterior-inferior quadrant, healed. No significant difference was demonstrated between the two types of dressings. Both groups noted an immediate improvement in hearing of 10.8 and 9.3 dB, respectively, after application of the dressing.

The study demonstrates that application of an occlusive dressing or paper patch in 30 per cent of patients can promote the healing of long-standing perforations. The chances for healing are better if the perforation is located in the posterior part of the TM. This simple technique immediately improved hearing and should be tried before a patient is referred for myringoplasty surgery.

A study was carried out in order to obtain further information about the soft tissue response to thin Apaceram® discs of dense hydroxyapatite (HA) implanted in rats for various periods of time between one day and 10 months. The Apaceram® discs were implanted subcutaneously into the interscapular region of 33 rats. A sham operation was performed on eight rats used as controls. Decalcified histological sections stained with haematoxylin and eosin and Mallory's azan were examined and the different cell types found around the implants were counted. It was found that an acute inflammatory reaction occurred after one day and disappeared at about two weeks after implantation. In the test groups, macrophages and lymphocytes disappeared about one week later, and no inflammatory reaction was observed from one to three months. However, a tissue reaction occurred at six months with the appearance of macrophages and lymphocytes, and decreased gradually at 10 months. Meanwhile, a few foreign body giant cells at the Apaceram®-tissue interface and a thick layer of fibrous connective tissue around the Apaceram® disc were observed at 10 months. No osteogenesis was observed in any specimen. The results obtained so far suggest that Apaceram® is still a useful material for reconstructive surgery, despite the possible appearance of a slight macrophage reaction at six months.

Forty cases of failed combined approach tympanoplasty were analysed. The commonest cause of failure was adhesions between the facial ridge and the tympanic membrane, causing segmental attico-mastoid malaeration in 51.3 per cent of cases followed-up continually. Other causes were, large dermoids, incomplete removal of squamous epithelium, and eustachian tube obstruction. Eustachian tube dysfunction did not appear to be a major cause of failure.

This study reviews 57 papers dealing with the issue of hearing preservation in vestibular schwannoma surgery published in otolaryngologic and neurosurgical literature between theyears 1977 and 1994. The authors', in this review, have made an attempt to verify whether the claims of hearing preservation are real, whether there is a price to be paid in terms of morbidity and whether there are univocal criteria for reporting results. The review shows that there is a wide disarray in reporting hearing results and the claims of hearing preservation are often unreal and misleading. On retabulating the results of a few series according to the minimal prerequisites for normal hearing (PTA ≤3O dB and SDS ≥70 per cent) and according to other various commonly reported criteria, it became evident that rates of hearing preservation differeda lot depending upon criteria. While any measurable hearing could be preserved in many cases, only a few had normal hearing preserved.

Otitis externa and chronic otitis media often present to the otolaryngologist with a discharging ear. The conventional method of treatment is to perform regular aural toilet and insert medicated dressings into the external auditory canal. This treatment is either performed by trained nurses or medical staff, but in either case is time consuming.

This study compares the efficacy of the above standard regimen with a novel treatment where a single aural toilet is carried out and medicated ointment instilled into the ear. Both regimens were evaluated at three weeks.

Our results shows that there was no significant difference between the two treatment regimens with regard to the resolution of either of the conditions studied or the improvement in the symptom status of the patients. On the basis of this it would seem that a single aural toilet and instillation of medicated ointment is a valid treatment option, cuts down hospital attendance and could be performed in the community by general medical practitioners or trained practice nurses.

In order to clarify the role of mast cells in the aetiology of secretory otitis media (SOM), we compared the protein components of middle ear effusion (MEE) with human mast cells using acrylamide gradient gel electrophoresis and electrofocusing methods. This first direct comparison between the proteins of MEE and human mast cells has been made possible by a method developed in our laboratory for cultivation of human mast cells in tissue culture.

On electrophoresis, we found that out of 12 bands of MEE proteins that were different from the serum, seven (58 per cent) had a similar electrophoretic migration rate (Rx) to mast cells. On electrofocusing, three of the four bands of MEE had a similar Rx to the mast cells. We have shown that proteins of mast cells and MEE had similar Rxs. Therefore, our study supports previous studies which suggests that mast cells play an important role in the aetiology of SOM.

Pigmentation is reported to affect cisplatin-induced ototoxicity in adult humans. The hearing loss is worse in people with brown irises, than in those with blue irises. We assessed the hypothesis that cisplatintreated children with dark irises suffer more deterioration in auditory thresholds than do those with less pigmentation. For the 19 children whose data met the requirements of this observational retrospective study, we found a weak correlation (Spearman's r = 0.50; p>0.05) of high frequency hearing loss (at 4000 Hz) and pigmentation. Blue or hazel-eyed children averaged 2.9 dB worsening at 4000 Hz, in contrast to 14.2 dB worsening for brown or black-eyed children.

Pigmentation may account for some of the individual susceptibility to cisplatin ototoxicity. We suggest that iris colour be included in future reports of cisplatin-related hearing loss

The clinical and pathological features of glandular tumours of the external auditory meatus are presented. Their heterogenous clinical and pathological features make the collective term ‘ceruminoma’ ambiguous andmisleading. The spectrum of pathological behaviour and histological features demonstrated by these interesting tumours necessitate a broader classification system. In our hospital 32 patients presented with tumours of the external auditory meatus over a 30-year period, of which seven were glandular in origin. A review of the histology of these glandular tumours enabled us to reclassify them as adenoma, cylindroma, adenoid cystic carcinoma or ceruminous adenocarcinoma. Together with the less common mucoepidermoid carcinoma and pleomorphic adenoma this subdivision forms a basis for a more meaningful classification system with prognostic and therapeutic implications specific to each tumour type. The term ‘ceruminoma’ should no longer be used unqualified.

Occupational rhinitis has been a prescribed industrial disease in the UK since 1907. It has only relatively recently received significant attention from otorhinolaryngologists although numerous studies have been performed in the past by occupational and industrial health physicians. At the present time the precise mechanisms of pathogenesis are unclear and would appear to be multiple.

Recently interest has arisen because of compensation claims. Diagnosis made on the basis of the clinical history is subject to two problems: firstly, there is difficulty in differentiating between occupational and nonoccupational rhinitis, and secondly, clinical histories can easily be feigned. Physical signs would be a more reliable indicator of occupational damage to the nasal mucosa if they differ from the signs normally found in allergic or vasomotor rhinitis. In a series of 100 shipyard workers dry atrophic nasal mucosa was found in 66and septal ulceration in two. From their clinical histories 78 individuals complained of nasal obstruction, 28 of epistaxis, 42 of hyposmia, 10 of anosmia and 90 of rhinorrhoea. Possible pathogenesis is described

Seventy-four patients undergoing bone pate repair of the long process of the incus as part of a tympanoplasty are presented. Mean follow-up time was 66 months (range 12–143 months). Hearing results are averaged over the frequencies 500, 1000, 2000 and 4000 Hz. Thirty-two per cent of the patients had hearing thresholds better than 30 dB pre-operatively. A significant improvement in hearing was seen (p<O.OO1). The data were also analysed to assess the effect of the pre-operative state of the tympanic membrane on the final result. The pre-operative condition of the tympanic membrane was either perforated (35 ears) or atrophic (33 ears). Six tympanic membranes were intact but these were excluded from the final results. No difference in hearing result was found between patients who had an ossicular repair in combination with either a perforated tympanic membrane repair or an atrophic membrane repair. Average hearing gain in the perforated group was 13 dB, in the atrophic group 9 dB and in the intact group 7 dB.

For many years vestibular testing has relied on measurements of the vestibulo-ocular reflex (VOR). More recently quantified assessment of balance, using fixed or moving force platforms and magnetometry have been applied to clinical research. These are objective attempts to quantify the vestibulospinal reflex (VSR). This study evaluates whether SwayWeigh, a simple device which measures lateral body sway, can provide an objective assessment of balance dysfunction. Forty patients with a balance disorder and 31 subjects with normal balance were tested with eyes opened and eyes closed whilst they were standing on a flat surface and then on an air bed. The lateral sway in patients with a balance disorder was compared to that in the normal subjects and highly significant differences (p<0.0001) were observed. The results also confirmed the importance of vision and proprioception in the maintenance of posture.

The Sway Weigh balance platform is a simple and economical device which objectively measures balance dysfunction.

Motorcyclists are known to be exposed to excessive wind noise levels when riding. The potential adverse effects of this exposure on their hearing was investigated. Temporary threshold shift (TTS) was assessed by asking 18 riders to undertake a standard test run of one hour at a steady 80 mph, and performing audiometry before and immediately afterwards. Permanent threshold shift (PTS) was assessed by performing pure-tone audiograms on a highly screened group of 246 motorcyclists and comparing their hearing thresholds with those of an appropriate control group obtained from the MRC National Study of Hearing.

Significant TTS was found at 0.25, 0.5,1 and 2 kHz. The greatest TTS occurred at 1 kHz, with a mean hearing loss of 10.3 dB. The hearing thresholds of the motorcyclists were significantly worse than the controls at 0.25, 0.5, 1 and 2 kHz, andwas most marked at 0.5 and 1 kHz where their hearing loss (PTS) was, respectively, 3.7 and 3.6 dB greater than expected.

These findings demonstrate evidence of both temporary and permanent hearing loss from motorcycling and present a strong argument for the need for some form of remedial action.