Forty-two patients affected by acute idiopathic peripheral facial palsy (AIPFP) underwent auditory brainstem evoked potential (ABEP) investigation in order to further our understanding of the nature of facial palsy. Twenty-two of these patients suffered from diabetes mellitus. Our results indicate that the AIPFP of the diabetic person may be considered as a preliminary sign of diabetic peripheral neuropathy.

Microfractures of the temporal bone have been recognized for more than seventy years and occur in certain well-defined areas of the otic capsule. The etiology and significance of these microfractures has been debated since their discovery. The most commonly held theory is that they result from stresses within the otic capsule that develop with growth. An alternative explanation might be that they result from masticatory stress placed upon the temporal bone.

Fifty serially-sectioned temporal bones from the Ontario Temporal Bone Bank were examined in this study for the presence of microfractures. Our findings as to the most common sites of microfractures agree with previous studies.

It is proposed that the constant stress placed upon the petrous temporal bone by the act of mastication is directed by the anatomy of the external, middle and inner ear through certain definite pathways, including the Fallopian canal, the bony semicircular canals and the cochlea. The most common sites of these fractures represent sites of weakness in the path of these directed forces within the otic capsule, and the statistically significant increase in the number of fractures with age lends support to the masticatory stress theory.

Middle-ear effusions of the mucoid type were collected from 14 children with secretory otitis media and analysed by a sensitive assay for hyaluronic acid. The concentration of the polysaccharide varied between three and 42 μg/g. in different patients but was in the same range in effusion material taken from the two ears of the same patient. As the hyaluronic acid concentrations were high compared to the serum levels, the results indicate that the effusion material contains a component derived from connective tissue.

In a study to determine whether or not there is a familial or hereditary pre-disposition to develop secretory otitis media (SOM), the parents of 73 children with presistent SOM and 35 controls were examined clinically, and abnormalities of the tympanic membrane (TM) noted. Analysis of the findings suggests that heredity plays a large part in determining a child's likelihood of developing SOM.

Seventy-nine children have been followed with persistent middle ear effusion (MEE). They were scheduled for myringotomy and insertion of ventilating tubes (VT). Several factors delayed elective surgery for two-and-a-half years in a closed population. After that period, the children were again examined otomicroscopically and hearing tests were performed. MEE persisted in 69 per cent of the ears, but was absent in 31 per cent. Atelectasis appeared in 26 per cent of the ears; in only a very few cases did severe atelectasis develop. Complications following delay of myringotomy and introduction of VT are minor.

The caloric test response from the unaffected ear in a case of acoustic neuroma may be normal, hypoactive or hyperactive; each has a different pathophysiological connotation: a normal response is the anticipated finding; a hyperactive contralateral response is due to the presence of a large neuroma with brainstem compression; and a hypoactive response may result from several factors, such as lack of mental alertness during the test, drugs like barbiturates, raised intracranial tension, or the presence of bilateral neuromas.

The anatomy and physiology of the middle ear transformer mechanism in man and a species of rodent, desmodillus auricularis, are compared. This rodent's middle ear mechanism has a transformer ratio of 147: 1 as compared to 18, 3:1 in man—some 8 times greater. The reasons for this difference are given and possible applications to middle ear surgery are suggested.

The process of development of the crista ampullaris has been investigated in the mouse using SEM.

Cristae ampullaris of the CBA/CBA mice, from the 13.5th gestational day to the day 2 weeks by were studied.

On the 13.5th gestational day, there were numerous microvilli and a primary cilium on the crista ampullaris. Sensory hairs first appeared on the 14.5th gestational day. The kinocilium and stereocilia were short and the length of the stereocilia was almost constant. The formation of the cupula, which had fine networklike structures, started on the 14.5th gestational day.

In a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant—antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p=0.06).

Scanning electron microscopy is commonly used to study the normal or pathologically altered cochlear epithelium. It is especially useful for the study of ototoxicity in humans or animals. A cochlear microdissection technique in the guinea pig is presented which permits examination of the whole membranous cochlea with little artefactual damage to the sensory structures under study.

A questionnaire on medical treatment of childhood secretory otitis was posted to all Consultant Otologists in the Thames Regions of the National Health Service. Questions dealt with indications for medical management, choice of treatment, and indications for omitting medical therapy in favour of immediate surgery, or giving no treatment at all. 86 questionnaires were completed. 81.4 per cent of respondents used medical treatment, but there was no consensus as to the drug or combination preferred. Oral decongestant preparations were the most popular. 87.1 per cent of users of medical therapy sometimes omitted it in favour of immediate surgery, most commonly because previous treatment by another practitioner appeared a failure. 63.1 per cent of all respondents left some cases completely untreated. The views of experienced otologists on the treatment of ‘glue ear’ vary widely, and there is no acceptable evidence to support any method of medical therapy. Large-scale trials are needed to clarify the position.

From 684 cases of ear surgery for cholesteatoma performed by one surgeon, 35 had labyrinthine fistulae (incidence 5.1 per cent). Of these fistulae, 79 percent involved the lateral semicircular canal only; the other sites involved were the other semicircular canals and the cochlea. The fistula test was positive in 54 per cent of cases overall, but in 80 per cent with an extended site fistula (ESF). Three surgical approaches were employed sequentially—staged combined approach tympanoplasty (CAT), open cavity tympanoplasty and attico-antrotomy. Surgically-induced deafness occurred in 3.3 per cent. All surgical groups showed similar hearing results, except for less conductive deafness in the CAT group. Surgical management is discussed with reference to current theories of the erosive effects of cholesteatoma.

The migration theory of cholesteatoma formation considers that stratified squamous epithelium from the external auditory meatus migrates into the middle ear, giving rise to cholesteatoma. To test the ability of squamous epithelium to migrate in this manner, 73 stains were placed in relation to 23 chronic perforations. In no instance did epithelium migrate into the middle ear cleft. The limitations of the migration theory are discussed.