ABR were recorded in 68 cases suffering from severe acute closed head injuries. Abnormal recordings were observed in 60 per cent of patients, and the abnormalities ranged from prolongation of the interpeak latency intervals to complete absence of auditory brain stem activity. Based on the results obtained, a grading system was developed and correlated with the neurological outcome. It was concluded that ABR is a useful diagnostic and prognostic tool which can provide valuable information about the function of the brain stem in these patients. Inclusion of ABR studies in the head injury management protocol is strongly recommended.

The most common serious long-term consequence of neonatal endotracheal intubation is acquired subglottic stenosis (SGS). The incidence in intubated infants is variously reported as between one and eleven per cent but this may be a relatively high range, reflecting the interest of the reporting centres and the various methods of diagnosis. (Fearon et al., 1966; Parkin et al., 1916; Strong and Passy, 1977; Papsidero and Pashley, 1980; Jones et al., 1981; Sherman et al., 1986).

In one study conducted at University College Hospital London (UCH) we reported an incidence of 1.8 per cent of SGS in all intubated neonates in a three year period (1981-83); if only survivors were considered the incidence was 2.6 per cent (Quiney and Gould, 1985). The relatively high incidence during this particular time focussed our attention on SGS and the factors which might precipitate its occurrence.

Assessment of the maxillary antral mucosa in chronic sinusitis prior to surgery is notoriously difficult. Sinoscopy using a Hopkin's rod system is proving increasingly popular. The accuracy diagnosis of mucosal disease by this means in 26 antra is here correlated with histological evidence of inflammation and bacteriological evidence of infection in antral mucosal biopsies. It is shown that the surgeon's assessment of the mucosal appearance correlates well with the histology and bacterial culture. Absence of mucopus or bacterial growth on culture did not indicate absence of disease.

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.

About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated.

One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4–6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p<0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage.

Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty percent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.

Eight hundred and seventy-nine patients with Bell's Palsy were seen over a 10-year period. There was a distinct female preponderance and the peak incidence occurred in the second to fourth decades. There did not appear to be an increased incidence of either hypertension or diabetes but there was a definite increased risk during pregnancy. Half of the patients had an incomplete palsy and they all recovered within a few weeks of onset. Those patients with complete palsy but without evidence of degeneration also all recovered but took longer to do so. If degeneration was evident the chance of recovery was only 50 per cent. Steroids did not appear to influence the outcome of Bell's Palsy.

An alternative theoretical neuro-mechanical hypothesis is presented in the pathogenesis of middle ear effusion, along with a review.

Neomycin was instilled daily, uni-or bilaterally, into the middle ear of guinea pigs for three months. The cochleae were examined, by light and electron microscopy, six months after the end of treatment. The organs of Corti of the treated ears were completely destroyed, and in the most advanced lesions, were substituted by a single layer of very thin flat cells. In the spiral ganglion only some glial cells and a few neurons could be observed. All surviving neurons were myelinated, and their ultrastructure was greatly altered, with disappeared, losing it amorphous and filamentous components. The spiral limbus and the stria vascularis were atrophic and were also covered, in the final stages, by flat elongated cells. In view of its morphological characteristics, this epithelium may arise from the displacement of the interdental cells and perhaps from the cochlear surface of Reissner's membrane.

The purpose of the present study was to describe the audiological and vestibular deficit in patients presumed to suffer from chronic impairment of the blood supply to the labyrinth. Thirty-nine subjects affected by various pathologies often impairing systemic blood circulation, which also presented labyrinthine damage of unclear origin, were evaluated for a possible relationship between these two conditions. At the time of this study 80 per cent of the subjects showed also a certain degree of increased blood viscosity. The most common finding in the group was slow and progressive bilateral sensorineural loss of hearing. In most of the subjects the labyrinthine damage began with high-tone loss which, in time, became a flat curve. Less common, but still found in many patients, was a fluctuation in threshold. Short periods of spontaneous subjective improvement in hearing were accompanied by a better result in the Pure Tone Audiogram and Speech Reception Threshold. The discrimination scores remained generally lower than expected. Vestibular examination revealed pathological results for all the subjects in at least some of the tests. The mild subjective complaints concerning equilibrium could be explained by a central nervous system compensation.

Fifteen subject underwent nasal pressure gradient studies to determine the resistance profile of the nose. Seventy-nine per cent of nasal resistance to airflow occurred in the segment 0 cm.−2.8 cm. from the posterior margin of the anterior nares. The greater part of this resistance (43 per cent) occurred in the segment 1.5 cm.−2.8 cm. within the nose, and this area approximated to the site of the pyriform aperture.

Eighteen patients underwent a trial of radical trimming of the turbinates (12 patients) versus anterior trimming of the inferior turbinates (6 patients). Both operations produced a similar fall in nasal resistance to airflow, confirming that the region of the pyriform aperture was the site of maximum nasal resistance.

Whereas the radical operation significantly reduced the sensation of nasal obstruction, the anterior operation did not.

The results of the study are discussed with reference to previous work on the subject.

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.

A technique for producing frozen sections from the non-decalcified guinea pig cochlea is described. The sections can be utilised or various immunofluorescent studies, including the detection of humoral anti-bodies against different cellular elements in patients with cochleo-vestibular disorders. The technique assures the preservation of the cochlear architecture and the tissue antigenicity, and it avoids damage to the fine cochlear structural details.