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.

There is much controversial evidence that children gain weight to a significant extent following tonsillectomy, usually associated with a general improvement in health. One hundred and nine consecutive children undergoing tonsillectomy in Dundee for recurrent tonsillitis had their weights recorded pre-operatively, and twelve months after surgery were re-weighed and a symptom chart completed. The results showed the patients were generally not underweight before surgery as their median weight was on the 55th. percentile. Most parents reported an improvement in their child's appetite with a reduction in the number of sore throats after surgery. Their weights following surgery had increased by an average of 20 per cent over what would normally have been expected, but this increase in weight was not confined to underweight children, but to the entire group.

Malignant hyperthermia (MH) is a seemingly rare genetic myopathy. Hypermetabolic crises accompanied by a rise in body temperature to as high as 44°C are its hallmark. These are usually triggered by potent inhalation anesthetics or depolarizing muscle relaxants. Because of the extraordinary risk of death in patients who are at risk, otolaryngologists may be reluctant to operate on these patients. Ten such patients undergoing tonsillectomy and adenoidectomy, myringotomy with ventilation tube insertion, and nasal polypectomy were anesthetized with nitrous oxide, barbiturates, opiates, tranquilizers and non-depolarizing muscle relaxants without complication. The patients were not treated prophylactically with dantrolene. Cardiac monitoring and rectal temperatures were followed. All ten patients had vastus lateralis muscle biopsy performed and subsequent caffeine/halothane contracture studies completed. The contracture study was positive in eight out of the patients studied. No anesthetic or surgical complications were encountered. This study demonstrates that patients at risk of developing MH crisis can have otolaryngologic procedures performed safely while undergoing appropriately selected general anesthesia.

Labyrinthectomy for unilateral Meniere's disease may be complicated by persistent unsteadiness post-operatively. The aim of this study is to identify the unfavourable factors in recovery following labyrinthectomy. Twenty-one patients gave a detailed history and underwent neuro-otological, opthalmic and cardiovascular examination, as well as psychological and psychiatric assessment. Sedentary occupations, external health locus of control, extraverted personality, and an anxious and/or depressed psychiatric state were associated with poor post-operative recovery. These factors therefore should be taken into consideration in the pre-operative assessment and post-operative rehabilitation of labyrinthectomy patients.

Nasal polyps are a condition of uncertain aetiology but are associated with diseases of the lower respiratory tract, in particular, asthma and cystic fibrosis. Asthma may be mediated by mastcell reactions and the commonest allergen to degranulate mast cells is house dust mite. Mast cells have been shown to be degranulated in nasal polyps. This study looks at thirty-six patients who had nasal polypectomy and of whom fourteen were asthmatic to see if histamine wasreleased from polyp tissue and peripheral blood when they were challenged with antihuman IgE and extracts of house dust mite and mixed grass pollens. These results were compared with skin tests to these allergens. A release of above 15 per cent of the total histamine was considered positive. Eight patients released histamine from polyp tissue but only three patients released histamine with both anti IgE and allergen extracts. The release from blood compared well with positive skin tests (p >0.05 corrected chi square). Although allergy may cause mast cell degranulation in polyp tissue, this study suggests that it is unlikely to be a common cause of nasal polyps.

A further new application of the fibreoptic laryngoscope as an adjunct to the excision of pharyngeal pouches is described. Its use facilitates the procedure and thus reduces the time of surgery. This is clearly advantageous, particularly as many patients with pharyngeal pouches are elderly and may be less than fully fit especially if overspill from the pouch has caused recurrent chest infections.

The aim of the study was to compare synthetic monofilament suture materials with chromic catgut and silk in aural wound closure. Forty patients undergoing mastoidectomy or tympanoplasty were randomized to closure with either 30 PDS (Polydioxanone) to fascia plus 30 Prolene to skin, or 20 chromic catgut to fascia plus 30 silk to skin. Known or suspected factors affecting wound healing were recorded. Nine patients had post-operative wound infections. The infection rate was significantly lower in wounds closed with PDS and Prolene (χ2 = 6.05, p<.05), and in tympanoplasty operations (χ2 = 4.42, p<.05). Four patients suffered wound dehiscence, all four had been closed with catgut and silk. No other complication of wound healing was noted in the trial. In conclusion, PDS and Prolene are superior suture materials to catgut and silk in the closure of aural wounds.

The possible role of surgical manipulation in inducing local spread and cicatricial complications in rhinoscleroma is illustrated by the three cases discussed in this paper. This is especially so where is occasional presentation as polypoid lesions of the lower respiratory tract may mimic other more sinister lesions and lead to unwarranted invasive procedures by the unsuspecting clinician. The infective nature of the lesions must be appreciated and confirmed microbiologically for appropriate drug treatment to be used. The benefits of minimal surgical intervention are illustrated in the third case.

Most children with acquired subglottic stenosis require a tracheostomy. This paper describes the communication skills of children with tracheostomies before and after decannulation.

There are also a small number of children with acquired subglottic stenosis who do not require a tracheostomy. They are rarely referred for speech therapy. Quiney et al. (1986) in a retrospective review described this group as all having normal speech development. It should be noted, however, that the lack of comment of a speech delay in the medical notes is inconclusive. Unless there is an ongoing study with a speech therapist routinely assessing the speech and language development of this group, one cannot conclude categorically that this group is always free of problems in their speech development.

The SWT was performed on 30 patients with chronic haemolytic streptococcus maxillary sinusitis, and 5 controls with no streptococcus in their nose and throat. Foreign and patient's own organism were used as antigen. The lymphoblastic transformation was higher in control streptococcus free patients than in chronic maxillary sinusitis, more when using foreign than patient's own organism. The failure of cellular immune response as a contributary factor tochronicity of maxillary sinusitis is discussed. The possible value of prepared foreign streptococcus vaccine in prevention and treatment ismentioned.

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.

A head and neck oncology service serving the Islington and Haringey District was organized in 1985. It is based at the Whittington and Royal Northern Hospitals and is conducted in conjunction with the combined clinic of the Head and Neck Oncology Group at the Royal Ear Hospital (University College Hospital). This paper presents a surgery of the first year's experience during which 29 new cases of head and neck cancer were seem.