The distribution of carbonic anhydrase isoenzymes (CA) was analyzed in the developing endolymphatic sac (ES) of the mouse embryo and human fetus using immunohistochemical method. The primordial ES epithelium was labelled with CA I and CA II, but was weakly labelled with CA III and CA V. In the thirteenth and fifteenth gestational day (GD) mice, the ES epithelium was positive for CA I and CA II. After seventeenth GD, the ES epithelium was however weakly positive for CA I and CA II. In the 11 and 12 week old human fetus, the ES epithelium was strongly labelled with CA I and CA II. In the 16 week old human fetus, the ES epithelium was however weakly positive for CA I and CA II. These results suggest that the fetal ES has an activity of CA and plays a role in the otoconial formation especially in the early stage during evolution.

A prospective study of 46 consecutive patients with nasal septal haematoma admitted at the General Hospital, Owerri, Nigeria over a five year period is presented. The disease was commoner in males than females. The majority of the cases (65.6 per cent) were of unknown cause and were therefore grouped as spontaneous haematoma while 30.4 per cent were due to trauma. Trauma was more common in patients below the age of 15 years while spontaneous haematoma was common in patients above that age. All the patients with septal haematoma represented 0.2 per cent of total attendances to the ENT clinic over the period. Most of the patients presented with severe and threatening symptoms necessitating intense aggressive management. All the patients were managed by surgical incision and drainage, four had marked nasal abnormalities. Three patients died from a brain abscess as a complication of infected haematoma.

The value of otoacoustic emissions as an objective screening test for normal peripheral auditory function in infants is currently the subject of extensive and promising research. Additionally the measurement of cochlear emissions is potentially useful when children cannot be tested reliably by traditional subjective methods but confirmation of normal hearing is diagnostically important. Three groups of children are described who present such audiological dilemmas: children with non-organic hearing loss, children with severe learning difficulties and more rarely children with an abnormal auditory brainstem response who also have damage to the central nervous system. In all three groups otoacoustic emission testing was found to be diagnostically useful in determining normal peripheral auditory function thereby resolving some of the dilemmas facing paediatric audiology and ENT clinics.

The complications of chronic suppurative otitis media as seen in 117 patients are presented. Fifty per cent of the patients had cholesteatoma, and 28 per cent revealed complications. Two-thirds of these complications, especially the serious intracranial ones, were encountered in young females. This female predominance was attributed to late presentation because of social reasons, or to undue susceptibility to the destructive effect of cholesteatoma.

Radical and modified radical operations were recommended to render the ears safe, as most of the patients came from distant rural areas and were judged to have poor compliance to report for regular checks.

Deviations in facial form are discussed. On the basis of previously published hypotheses, it is suggested that oropharyngeal development may be influenced by the posture, and function of the tongue, lips, and jaws. Attention is drawn to the relationship between a firm tongue to palate swallow, and the pump action of the palatine aponeurosis, which it is suggested is necessary for the aeration of the Eustachian tube. The pump action appears to be reduced in long faced adenoidal children, but clinical evidence suggests that it can be regenerated by early Orthotropics (growth guidance) aimed at directing facial growth forward, instead of downward. Any reduction in the height of the face, facilitates an improved lip seal, without which the downward pattern of facial growth is likely to continue. On occasions when these objectives are achieved it would seem that sufficient room is created to align all 32 teeth, with excellent facial form, and little otolaryngological pathology.

The long-term results of 63 total ossicular chain reconstructions using autografts is presented. The follow-up period ranged from 18 months to 18 years with an average of 8.5 years. The primary aims of the study were firstly to assess the long-term success rate and to find out if there were any hitherto unknown causes of bone graft failure. In the event, it was found that the recently described anatomical variation of the oval window viz., the deep oval window, was the prime cause of failure in 32 per cent of unsuccessful cases. Some measures to help to mitigate this problem, are suggested. The result were assessed on the basis of:

1. A minimum gain of 20 dB HL in air conduction (Technical success). The success rate was 55.5 per cent.

2. Patients benefited using Smyth and Patterson's criteria in conjunction with the Glasgow Benefit Plot; 54 percent of the patients benefited significantly.

Until it is accepted that many of the recommendations for surgical treatment of middle ear disease, based on impressions formed twenty years ago, are misleading, attempts to rationalize the use of hospital resources will be little more than cosmesis. Responsibility for the initiation of cost-effective reform is primarily that of surgeons and requires urgent self-audit and the provision of realistic advice to patients (and administrators) as to what benefits microsurgery of the ear can offer.

There are a variety of approaches for treating vertigo with selective vestibular neurectomy but each has definite limitations proving that no ideal technique is yet available. An original posterior-inferior approach to the internal auditory canal (infralabyrinthine approach) has been recently proposed. It attempts to overcome the limitations and to combine the advantages of the previous procedures. This report presents our preliminary results using this particular technique in the management of vestibular symptoms of Meniere's disease.

A personal series of 842 patients with a tumour of the oral cavity is presented. Five hundred and twelve of these patients had a histologically proven squamous cell carcinoma, and were previously untreated.

Increasing age was associated with worsening performance status. Women were older at presentation than men, and tumours of the upper part of the mouth were more common in the elderly, but there was no relation between age and histological grade or stage grouping.

Sex had no correlation with performance status or histological grade. However, men were more likely to have an advanced tumour, and tumours of the floor of the mouth and alveolus were much commoner in men.

There was no correlation between performance status and site or histological grade, but patients in poor general condition were more likely to have stage III-IV tumours.

Multivariate analysis showed that sex had no impact whatever on survival, but survival fell with increasing age and worsening performance status. The effect of age and performance status disappeared when the survival of treated patients was adjusted for deaths due to other causes.

Otoscopy is a subjective clinical method. Its subjectivity has led physicians to verify its accuracy through correlations with findings of otomicroscopy, pneumatic otoscopy, tympanometry, and myringotomy. In the very young population, however, the interpretation of otoscopic findings becomes more difficult. To improve the interpretation of normal otoscopy in young children, an otoscopic-histological correlation was attempted in children up to nine years of age. Twenty-one temporal bones from 15 children aged from two days to nine years who had no evidence of otological disease or congenital anomalies were examined under light microscopy; the thickness of the pars flaecida, posterior superior quadrant, and umbo were measured. Twenty-five eardrums of 15 healthy children without past or present history of otological disease were examined using otoscopy; a photograph of each eardrum was obtained. Our study demonstrates that structural changes in the tympanic membrane during these years of childhood have a good correlation with otoscopic findings. Understanding normal histological changes in the paediatric eardrum may improve our interpretation of otoscopic findings.

In our histological examination on 42 ears (auricles) which were taken from 18 fetus and three adults, the intracartilaginous fibrous tissue with blood vessels and lymphatics were found in 12 ears and interruption of the auricular cartilage in 22 ears. The intracartilaginous connective tissue with blood vessels and lymphatics were linked together with the connective tissue outside the auricular cartilage in other sections. These findings support the hypothesis of congenital embryonic dysplasia as the origin of the formation of pseudocyst of the auricle.

We studied the seroprevalence of antibodies to Chlamydia pneumoniae, the third species of chlamydia, in patients with acute infections in otolaryngeal sites. The patients were divided into five diagnostic groups, i.e. sinusitis, otitis media, tonsillitis, laryngitis and bronchitis group. Antibodies were measured by the microimmunofluorescent method. Antibodies confirming past infection with C. pneumoniae were found 46.2 per cent of the patients in the diagnostic groups and 44.7 per cent of the subjects in the control group. The difference between these two groups was not statistically significant. Acute or recent antibodies were detected in 10.5 per cent (2/19) of these patients with sinusitis, 19.2 per cent (10/52) of those with tonsillitis, 23.5 per cent (8/34) of those with otitis media, 18.2 percent (6/33) of those with laryngitis and 22.8 percent (13/57) of those with bronchitis, whereas only one member of the control group had acute antibodies. These data suggested that C. pneumoniae is an important and common pathogen of otolaryngeal disease.

The reported incidence of persistent tympanic membrane perforation after the extrusion or removal of Goodetype tympanostomy tubes varies from 3 per cent to 47.5 per cent.

A prospective randomized study of 152 Goode-type T-tube removals is presented. In one group of 79 ears, the edge of the defect was just freshened, but in the other 73 ears, the edge was freshened and a small piece of 0.13 mm silastic sheeting placed over the defect. Follow-up was performed at six weeks and three, six and nine months and shows that the use of silastic sheeting increases the rate of closure of the perforation and also significantly decreases the number of persistent perforations at nine months.

Draffin's rods or bipods are now a well-known, internationally accepted ENT instrument. Before their invention in 1951, the attendant anaesthetist or nurse was obliged to support the mouthgag during tonsillectomy.

Research into the life of their originator, David Alexander Draffin, reveals that in addition to his evident design skills, he was a surgeon of courage, wit and great charm.

The role of the rigid endoscope has been evaluated in the management of 36 cases with dry central perforation of the tympanic membrane. The graft take rate was 91.7 per cent and the air-bone gap was closed to less than 10 dB in 83.3 per cent.

The use of the rigid endoscope in the management of dry central perforation of the drum represented a significant advance in middle ear surgery. It is used, in correlation with manometry, to evaluate the tubal function before ear surgery and to treat hidden causes of tubal obstruction. It replaces the operating microscope in observation and surgery of the tympanic membrane perforation. It overcomes anatomical variations that hamper access to the entire tympanic membrane during ear surgery. It provides an extremely sharp image with high resolution.

Surgical closure of the anteriorly located tympanic membrane perforation can present a problem. The lack of anterior support for the graft frequently leads to graft failure if an underlay method is used whereas anterior blunting is a complication of onlay techniques in this situation. The experience with the Kerr flap, an underlay graft fashioned to include a tab of fascia which is placed laterally under the annulus and the anterior meatal skin, is presented. This method gave a 97.5 per cent closure rate with no cases of anterior marginal blunting and a mean auditory threshold gain of 8.5 dB (95 per cent confidence limits 5 to 11.9 dB, P<O.O1) was achieved at the frequencies tested. The use of the Kerr flap is recommended when repairing the anteriorly placed tympanic membrane perforation

Widespread controversy exists concerning the treatment of traumatic tympanic membrane perforations. To elucidate the issue, a reference value for the rate of spontaneous tympanic membrane closure in man, to which the healing rates following different techniques of early surgical repair should be compared, was established on the basis of a review of more than 500 texts covering a century's literature on the traumatically perforated tympanic membrane. The spontaneous healing rate appeared to be close to 80 (78.7 per cent) in 760 evaluable cases of traumatic tympanic membrane perforations of all sorts diagnosed within 14 days post injury. A relative, causal-related variation of spontaneous healing could be demonstrated, and a pathogenetic classification of direct traumatic tympanic membrane perforations into ruptures induced by air-pressure changes, heat or corrosives, solids, and water pressures, is of proved clinical value and may have medico-legal validity. There is an obvious need for clinically controlled studies on the spontaneous healing of all kinds of traumatic perforations of the tympanic membrane in humans, and important elements in the design of future studies are advocated.

A questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners.

The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.

Forty-five patients who were to undergo elective urological operations were evaluated. In the pre-operative period and on the third or fourth post-operative day audiometry was performed. Epidural anaesthesia was performed in 15 cases, spinal anaesthesia was performed in 15 cases with 25 G needles, and in 15 cases with 22 G needles. No statistically significant hearing loss was observed in the post-operative period compared to preoperative period in the epidural anaesthesia group. In the post-operative period, the hearing loss observed in the 25 G-spinal anaesthesia group was significantly (P<0.01) less than that seen in the 22 G group. None of the patients had headache after spinal anaesthesia. It was concluded that pure tone audiometry is a more sensitive indicator of cerebrospinal fluid leakage than post-operative headache.