Intravenous lidocaine is known to have an effect on the auditory system in that it is useful for suppressing tinnitus, albeit temporarily. We have used intravenously administered lidocaine as one of the treatment modalities for refractory, disturbing, tinnitus. Its effects on the vestibulo-ocular system were determined by elec-tronystagmography performed before and immediately after injecting lidocaine: smooth pendular stimulus tracking was unaffected; spontaneous and positional nystagmus tended to be suppressed; directional preponderance was reduced or reversed; and the difference between the nystagmus responses in the two directions during the pendular rotation chair test was also reduced or reversed. These changes in the caloric and rotation tests were statistically significant. Lidocaine also appeared to have altered the balance between the two sides in the vestibulo-spinal system as indicated by the results of the stepping test during craniocorpography. The results lend support to the hypothesis that intravenous lidocaine acts at the level of the central nervous system rather than at the periphery.

Records of septoplasties performed during the last five years were reviewed with the aim of evaluating the results of routine pre-operative radiological examination of the sinuses. A positive correlation was found between the information of sinusitis within the last two years and the radiological finding of complete density or fluid. The roentgenograms showed normal conditions in 73 per cent of the cases and various degrees of pathology in 27 per cent; no case showed signs of malignancy. Puncture and irrigation or sinoscopy had been performed in 52 per cent of the cases with pathological X-rays. Following this treatment, surgery was postponed in 12 patients, and in nine patients a drainage tube was placed in the maxillary sinus per-operatively. Complications developed post-operatively in five of these nine patients and it is concluded that septoplasty should have been postponed. We find that it is important to identify the four per cent (12+9) of patients in whom the radiological findings are so pronounced that operation ought to be postponed.

Nasal mucus clearance (N.M.C.) varies with geographical conditions. Studies on the evaluation of this important function have so far been done only in the western part of the world, but now the normal values of N.M.C. in India have been established by measuring the transportation of saccharine crystals through the nose. This has been compared with the values obtained in various diseases of the nasal and lower respiratory tracts, thus establishing the prognostic and diagnostic importance of measuring the nasal mucus clearance.

A Transcannular Tru-Cut needle maxillary antral biopsy technique, which has been devised as an out-patient procedure to speed up histological diagnosis in antral disease, is here described. A trial carried out with this technique shows that the histological diagnosis reached from such biopsy specimens compares favourably with that reached from specimens taken through an intranasal antrostomy.

We reviewed clinical findings in 740 patients over age 65 who consulted the Otological Medical Group, Inc., during a one-year period for dizziness. A thorough neurotologic evaluation is indicated in every such case to determine the specific cause of dizziness. In 21 per cent of these patients, a specific cause of dizziness was found. In the remaining 79 per cent, the diagnosis of primary dysequilibrium of ageing (presbyastasis) was made.

We classified dysequilibrium of ageing (presbyastasis) according to the character, time course, and precipitating factors of dizziness. Two clinical types were described: constant and unclassified. The histological finding in the temporal bones of four cases with dysequilibrium of ageing were reviewed. Pathological changes other than those in the peripheral vestibular system seem to be responsible for dysequilibrium of ageing.

In the present series, about three-fourths of the patients had a daily dose of nicotinic acid to produce flushing of the skin. In 16 per cent, the dizziness was minor, requiring no special treatment. In the remaining 9 per cent with incapacitating vertigo, a vasodilator regimen, antivertiginous drugs, and Cawthorne's vestibular exercises were prescribed.

Atresia of the posterior nasal choanae is an unusual congenital condition. The embryological explanation is uncertain, that felt to be the most probable being presented here. Bilateral choanal atresia tends to be associated with neonatal airways obstruction and steps to be taken in its diagnosis and management are outlined. The definitive treatment of the condition is surgical excision, by either a trans-nasal or a trans-palatal approach. The conclusions arrived at as to the most effective method of management of these cases from a personal series of fourteen cases are detailed. A preference for the trans-nasal surgical approach is indicated and surgical details for this method are given, some aspects of which have not been previously reported.

A technique of trans-septal approach to unilateral bony choanal atresia in the older child or adult is described with the advantages of better exposure, less bleeding and better mucosal cover of raw bone than traditional methods. This seems to reduce post-operative re-stenosis at the site of the atresia.

Oxymetazoline, a derivative of imidazoline, is a widely used nasal decongestant. In contrast to other topical decongestants related to phenylephrine, sympathomimetic amines, it also induced a reduced nasal mucosal blood flow. The purpose of the present investigation was to evaluate the duration of effect of oxymetazoline on nasal airway resistance and mucosal blood flow. During the eight hours of study, the blood flow was reduced by 30–40 per cent in six hours. A similar decongestant effect of about 30 per cent was found during the same interval. The pharmacological profile of oxymetazoline seems questionable, since a reduced nasal mucosal blood flow might not be of value in the treatment of upper airways infections.

The saccules and ampullae of the semicircular canals from human and guinea pig temporal bones were fixed in glutaraldehyde without osmium. Crosslinks were seen between stereocilia of the vestibular hair cells, similar to those previously demonstrated in the guinea pig, although an additional set of crosslinks was displayed: first, horizontal crosslinks were seen between adjacent stereocilia, occupying most of the length of the hair bundle; secondly, a single upward-pointing link ran from the apex of each shorter stereocilium into the shaft of the adjacent taller ster-eocilium; thirdly, an extensive array of horizontal links were demonstrated between stereocilia close to their insertion into the cuticular plate. We suggest that these basal crosslinks support the long vestibular stereocilia rendering them more rigid, and that the upwind pointing crosslinks are responsible for the initiation of sensory transduction.

The 1972 AAOO committee (Alford, 1972) guidelines brought some uniformity into the evaluation of therapy for Meniere's Disease. We have adhered to its recommendations in this long-term follow-up report of 21 saccus decompressions and 29 vestibular nerve sections performed on 46 patients between 1968 and 1977. Comparisons between these and other groups have been possible with regard to: 1. control of vertigo; 2. hearing; 3. tinnitus; and 4. development of hydrops in the contralateral ear. All the vestibular nerve section group have enjoyed sustained relief from vertigo. Class D results (recurrent vertigo) account for 14 per cent of the saccus decompression group at one year and 29 per cent at eight to 10-year follow-up. Hearing levels in both groups deteriorated in parallel as time progressed but tinnitus became less noticeable. Nineteen per cent of the long-term review patients showed evidence of developing cochlear hydrops in the contralateral ear. Conservative surgical procedures should be employed whilst any useful hearing exists, though the emphasis remains on controlling vertigo. Saccus decompression, despite its controversial therapeutic basis, will remain the first-line surgical procedure for many otologists. However, in the fit young Meniere's cripple or saccus decompression failure with serviceable hearing, vestibular nerve section remains the treatment of choice.