Forty-nine children for tonsillectomy were entered in a prospective controlled single blind study to compare the post-tonsillectomy morbidity of bipolar diathermy as opposed to ligation for haemostasis. We found no significant difference in post-operative discomfort nor reactionary or secondary haemorrhage in the two methods used. This is the first controlled trial where bipolar, rather than unipolar diathermy is used, and compared with ligation in the operation of tonsillectomy

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinityto the mucosa of the upper respiratory tract. Involvement of maxillary antrum is said to be very uncommon. In the present study antroscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion in the maxillary antrum. The maxillary antrum was involved in 60 per cent of cases with rhinoscleroma. The lesions occurred in the form of atrophic changes, granuloma, and the fibrotic thick healed stage. The anterior–inferior part and medial wall of the antrum are found to be more commonly affected. It is suggested that involvement of maxillary antrum in scleroma may act as a reservoir of infection and such patients may therefore take a longer time to respond to antibiotic therapy.

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique.

In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.

The management of chronic ear disease affecting the only hearing ear is a controversial subject. The relative scarcity of literature on the subject prompted us to prepare a questionnaire which was sent to European and American otologists and to review 19 cases operated at the ENT Clinic of the University of Parma, Italy, and 16 cases operated at The Baptist Memorial Hospital, Memphis, U.S.A. Surgery of cholesteatoma involving the only hearing ear is advised by all the interviewed otologists without exception, even in the presence of a labyrinthine fistula. The cases from the University of Parma were managed as follows: a classic modified radical mastoidectomy was performed in 10 cases, a staged intact canal wall tympanoplasty was done in four cases, an open tympanoplasty in three and a radical mastoidectomy in the remaining two cases. The cases from The Baptist Memorial Hospital were managed with an intact canal wall tympanoplasty (ICWT) in nine and with an open procedure in seven cases. All the otologists interviewed agreed that surgery of the only hearing ear requires particular attention and experience, and should be performed with extreme care by a very experienced surgeon.

The relationship between sudden hearing loss and an ipsilateral patulous tube was tested in ourEustachian tube laboratory. Fifty patients suffering from sudden hearing loss were examined by the pressure chamber impedance method, giving objective data on Eustachian tube function. Results were compared to those obtained from 56 healthy volunteers in a preceding investigation. Ourinvestigation did not show any associations between patulous tube syndrome and sudden hearing loss, as had been claimed by several authors previously. There was even indication of a decreased patency of Eustachian tube in our patients in active and passive tubal tests. We could demonstrate a high reproducibility of values obtained by our method, indicating that results are representative in healthy persons as well as in patients.

In a case report the importance of objective diagnostic methods in differential diagnostics of Eustachian tube pathology is emphasized.

A prospective study of the effect of radiotherapy for nasopharyngeal carcinoma on hearing was carried out on 49 patients who had pure tone, impedance audiometry and auditory brain stem evoked response (ABR) recordings before, immediately, three, six and 12 months after radiotherapy. Fourteen patients complained of intermittent tinnitus after radiotherapy. We found that 11 initially normal ears of nine patients developed a middle ear effusion, three to six months after radiotherapy. There was mixed sensorineural and conductive hearing impairment after radiotherapy. Persistent impairment of ABR was detected immediately after completion of radiotherapy. The waves I–III and I–V interpeak latency intervals were significantly prolonged one year after radiotherapy. The study shows that radiotherapy for nasopharyngeal carcinoma impairs hearing by acting on the middle ear, the cochlea and the brain stem auditory pathway.

A middle ear effusion is a common complication of nasopharyngeal carcinoma both before and after radiotherapy. An effusion was found in 38 per cent of patients before radiotherapy and 9 per cent developed an effusion after the start of radiotherapy. Surgical treatment by myringotomy with or without grommet insertion was associated with a high incidence of otorrhoea (26 per cent) which was often refractory to treatment. In view of the frequency of this complication and the fact that a middle ear effusion may not be of concern to an adult patient with nasopharyngeal carcinoma, a ‘wait and see’ policy may be appropriate in the management of a middle ear effusion in these patients.

Results of 45 re-operations for persistent or recurrent conductive deafness after primary stapes surgery were studied. The mean follow-up period after the revision surgery was 7.6 years. Long-term hearing results were found to be disappointing, air-bone gap to within 10 dB was achieved in only 46 per cent of the patients. Mean hearing levels improved by 11 dB or more in 73 per cent. Outcome of surgery was dependent on the surgical pathology, the best hearing results were obtained in cases with re-fixation after stapes mobilization operation. Sensorineural hearing loss as a result of surgical trauma to the inner ear occurred in revision surgery more frequently than in primary operations, cases with regrowth of otosclerotic bone to the oval window after stapedectomy having the greatest risk of labyrinthine trauma.

The diagnosis of CSF rhinorrhoea on clinical grounds alone can be difficult. We describe how the use of noninvasive electrophoretic analysis of nasal secretions for tau protein (asialotransferrin) helped in the management of cases where the existence of a CSF leak was in doubt. Patients were thus saved unnecessary invasive investigations or surgery. A modification of the method of analysis, which improves diagnostic accuracy, is described.

The results of single modality treatment using surgery or radiotherapy alone in advanced head and neck cancers are known to be unsatisfactory. The present study analyses 252 cases with stage III and IV resectable cancers of the head and neck region selected to be treated by a combined regime of pre- or post-operative radiation and radical surgery. Only 193 patients completed the treatment protocol. There were 58 cases (33.5 per cent) who failed either at primary or regional sites or both. Nine cases (five per cent) developed distant metastasis. Absolute and determinate four year disease-free survival was 55 per cent and 61 per cent respectively. Early lesions (stage I and II) have been excluded from the study. The study indicates that a reduction in primary and regional failures correlates well with a combined therapy, though prolonged treatment may affect patients' compliance to some extent.

Idiopathic subjective tinnitus (1ST) is one of the most obscure otological pathologies. This paper presents the results of treating 1ST by intratympanic instillation of lignocaine (lidocaine) 2 per cent through a grommet, for five weekly courses. Fifty-two patients suffering from intractable tinnitus entered this therapeutic trial, but only nine finished all five courses. In one patient, the tinnitus was almost completely abolished, but in all the nine patients the decompensated tinnitus changed to a compensated one. We suggest this mode of treatment for patients that were previously treated by drugs, acupuncture and biofeedback, with disappointing results.Patients should be warned about the side effects of vertigo and vomiting, which subsides gradually with every new instillation, and that the tinnitus may not disappear but will be alleviated, enabling them to cope more easily with the disease and lead a more normal life.

Lateralization of one or both vocal folds is a generally accepted surgical principle for the relief of the airway obstruction caused by bilateral vocal fold paralysis. A modified, entirely endoscopic method of lateralization has been developed, employing a carbon dioxide laser to reduce the bulk of the fold, and fibrin glue to maintain the lateral position. The results of 18 operations on 15 patients, including six who had unsatisfactory results after previous surgery, were analyzed and compared retrospectively with the results from 22 patients operated on before the introduction of the method. The patient's ability to perform everyday activities improved in 12 cases, which paralleled the results of the previous, more cumbersome methods. The incidence of re-operation was comparable, given the shorter follow-up after the more recent method.

The use of a tracheo-oesophageal voice prosthesis was introduced to the Glasgow Royal Infirmary Otolaryngology, Head and Neck Surgery unit in 1986. Although it was the authors' impression that most total laryngectomees since then had been offered this method of voice restoration, it was thought that long standing laryngectomees were seldom offered tracheo-oesophageal fistula (TOF) speech. Therefore all 58 total laryngectomees currently attending the combined head and neck surgery/radiotherapy clinic were assessed. Thirtytwo had a tracheo-oesophargeal fistula with voice prosthesis. All of these patients had undergone their total laryngectomy since 1986 and 83 per cent had achieved TOF speech. The remaining 26 patients (who mostly had their laryngectomy before 1986) had not been offered TOF speech. An outpatient consultation was arranged for these patients and 63 per cent of those offered, accepted TOF creation and a voice prosthesis. When compared to those who refused, it was found that good oesophageal speech, age or interval since laryngectomy were not good predictors of likely refusal. This study indicates that all fit long standing laryngectomees should be offered secondary TOF creation.

A new surgical technique for the treatment of cholesteatoma is reported. The technique involvesautoexclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small.

The technique allows visual post-operative control of the attic and tympanic membrane. There isno visual access to the mastoid cavity which, however, is the most unlikely site for occurrenceof a residual cholesteatoma.

The proposed technique was applied to 102 patients and both the anatomic and functional resultsobtained are reported.

Forty-seven mucocoeles of the ethmoid and/or sphenoid sinuses (33 males, 14 females) were operated on during the 10-years period from 1980 through 1989. Thirty-seven cases were post-operative mucocoele, while the remaining 10 were so-called primary mucocoeles. None of the cases had a history of facial trauma. In the majority of post-operative cases, the mucocoele develops 15–24 years after initial surgery. Paranasal sinus surgery in young patients (teenagers) may lead to a mucocoele due to post-operative scarring in the surgical wound. The principal symptoms include globe displacement, double vision, headache, deep orbital pain, a mass in the supero-medial quadrant of the orbit, visual disturbance, etc. Sufficient opening of the mucocoele wall by the endonasal approach is recommended for surgical treatment of ethmoidal and sphenoidal mucocoeles

Allergic aspergillus sinusitis has recently been increasingly recognized. Five cases are discussed. All presented with proptosis, signs and symptoms of allergic rhinitis and radiological evidence of expansile masses with calcification and bony erosions involving multiple sinuses. Greenish cheesy material was seen at surgery. Histologically the lesions contained eosinophils, Charcot-Lyden crystals and fungal septate hyphae. Aspergillus fumigatus was grown from all cases. Surgical removal with drainage and aeration were performed. The follow-up period ranged between three to 18 months. Recurrence occurred in one patient.

Allergic aspergillus sinusitis can mimic malignant disease and should be considered in the differential diagnosis of lesions involving multiple sinuses. It should also be considered in all cases of proptosis.

A study of 50 consecutive patients undergoing myringoplasty using a Merocel Sponge Pope Ear wick as an ear canal dressing showed the wick to be complication free with potential advantages over the time honoured Bismuth Iodoform Paraffin Paste dressing.

In 1980, Bhargava et al. reported a new treatment of allergic and vasomotor rhinitis by the local application of 15 percent silver nitrate. The results of further studies of the treatment by using different concentrations of silver nitrate ranging from 5 percent to 25 percent and normal saline as placebo are presented here; 15 percent has been found to be the most effective concentration giving successful results in 75.7 per cent of cases. It is applied to the anterior portion of both inferior turbinates and the anterior part of the nasal septum once aweek on five occasions.

Best relief was obtained from the most annoying symptoms of sneezing and rhinorrhoea. Asthma was controlled in 50 percent of such patients who had attacks of allergic rhinitis followed by asthma.

For this widely prevalent disease, the treatment was found to be simple, easy and useful, with negligible side-effects.

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy.

Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.

Ten cases of large nasal septal perforation were repaired with a tragal cartilage inferior turbinate mucoperiosteal sandwich graft technique with 70 per cent success rate over a follow-up period of up to 24 months. The technique is described in detail. The results are comparable to other techniques.