This manuscript traces the traditions of the healing of the deaf associated with St Cadoc. While Saint Cadoc was Welsh, the traditions associated with him are found in Brittany. It seems likely that they originated there as pre-Christian healing traditions which were subsequently incorporated into those associated with the Church. The centre of these traditions was (and is) St Cado in the South of Brittany, near Carnac.

A longitudinal study was performed on 147 Jewish children with bilaterally sensorineural hearing loss of moderately severe to profound degree, born in Jerusalem during the eighteen years 1968–85.

The prevalence rate of these children declined during the years 1977–85, and at the same time the rate of consanguinity of their parents decreased; this decline was more evident in the genetic group among children with non-Ashkenazi ethnic origin. No such decline was found among the Ashkenazi children and no consanguinity among parents of these children was recorded.

Our study supports the assumption that restriction of consanguineous matings may affect the prevalence of genetic deafness in children in a well-defined population. We have tried to remain unbiased and concede certain shortcomings in our present study.

Qualitative and quantitative bacterial analysis of 200 samples of middle ear effusions collected from patients with current otitis media was performed. When middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis) where found during current acute otitis media or otitis media with effusion infection, the quantity of these bacteria was of the magnitude 106–108/ml and 0–5 × 105/ml effusion material, respectively. Mucopurulent effusion material contained 6 × 105–108 bacteria per ml whereas effusion from chronically discharging ears exceeded 109 bacteria per ml. Serous effusions did not harbour middle ear pathogens. The appearance of the effusion material was dependent on the number of bacteria involved. Quantification of bacteria in various middle ear effusions offers opportunities to make the diagnosis of various otitis media infections more accurate and readily comparable.

Many acoustic neurinomas and CPA tumours present an audiometric picture of positive-recruitment hearing impairment although often the CMs are not significantly impaired (according to ECochG) and because, even in the case of a small acoustic neuroma, the interpeak latency between wave I and V (ERA) is increased in the majority of cases. Recruitment cannot be explained, in these cases, as an expression of an accompanying vascular inner ear lesion. Therefore, we attempt to interpret the differential audiometric picture to the various patterns of damage of the auditory nerve. The finding of tone decay is seen as an expression of myelin damage corresponding to the hearing loss in multiple sclerosis.

The absence of any degree of tone decay excludes an isolated damage of the myelin sheaths; hearing loss then results from a disturbance also of the associated axons. At such a stage, where there is a functional loss to part of the neural fibres but with intact myelinated residual fibres, the result could be the phenomenon of recruitment for suprathreshold stimulation. This theory of selective compression is compared to an isolated efferent lesion theory as the cause for recruitment in AN and CPA tumours.

The diagnosis of a patulous Eustachian tube relies mainly upon the history, examination and a clinical awareness of the condition. More recently, objective tests such as tympanometry and sonotubometry have been shown to be useful in confirming the diagnosis. This paper describes how computed tomographic imaging may also be useful in aiding the diagnosis. Supporting this, clinical cases of patulous tubes are demonstrated radiologically associated with congenital hemifacial microsomia and following radiotherapy for a nasopharyngeal carcinoma. The role of computed tomographic imaging in the diagnosis, research and monitoring of treatment for his condition is discussed.

Deviation of gait in a stepping test has been proposed as a useful indicator of peripheral labyrinthine dysfunction. A prospective study of 26 patients suspected of having uncompensated peripheral labyrinthine dysfunction and 49 normal patients with normal labyrinthine dysfunction showed no significant difference in performance of the Unterberger stepping test between patients with electronystagmographically significant canal paresis and those with normal vestibular function.

The otic capsule is unique in retaining calcified cartilage, known as globuli interossei, throughout life and shows changes consequently, which are peculiar to it. In Paget's disease of bone, the otic capsule appears resistant to involvement and this occurs with extensive disease at a late stage. In contrast, otosclerosis is a new bone formation of unknown cause that is limited to the otic capsule. In osteogenesis imperfecta, the poor formation of collagen leads to abnormally thin bony trabeculae with a poorly formed otic capsule. In osteopetrosis, the otic capsule is greatly expanded by increased globuli interossei, as a result of defective osteoclast function. When fractured the middle layer of the otic capsule does not form callus, but heals by fibrosis.

Subtotal pars flaccida perforation was effected in vitro in rat tympanic membranes. The drums were subsequently kept in tissue culture and after various intervals studied by means of light and scanning electron microscopy. No complete covering of the perforation was seen, though a marked thickening and hyperplasia of the outer, keratinizing, squamous epithelium (OE) was evident. The inner, tympanal epithelium (IE) appeared swollen, containing rounded structures in the cytoplasm especially close to the contact area with the OE. Ingrowth of OE onto the tympanal side of the drum was seen particularly in the areas where the IE was sparse and completely lacking. Complete covering of a drum perforation seems to be dependent on the formation of supporting granulation tissue, probably resulting from an inflammatory reaction in the healing area.

The distribution of tympanogram types among 872 seven-year-old children from a random population sample was related to 14 features of the home environment reported by parents in a questionnaire. Parental smoking was an important determinant of middle ear underpressure and effusion, and accounted for much of the associations observed with dampness, crowding and rented accommodation. Gas cooking was associated with a higher prevalence of effusion, but a lower prevalence of underpressure; this may deserve further study.

After adjustment for seasonal variation, tenure and household smokers, the weekly mean temperature in the bedrooms of 34 children with Type B tympanograms was 18.2°C, compared to 17.9°C for 190 children with Type A tympanograms. The equivalent figures for bedroom relative humidity were 51.8 percent and 52.7 per cent. It is unlikely that heating or ventilation of the home is an important determinant of middle ear effusion and underpressure in this age-group.

Four cases of otitis externa secondary to radiotherapy are described. This fairly common complication of irradiation to the head and neck, may impede a satisfactory completion of the therapy. Water precautions and regular otoscopic examination of the ears should be encouraged as prevention or early recognition of the condition is essential for the well being of the patient. The treatment of established otitis externa consists of frequent aural toilet and the application of weak antiseptic solutions. However, complete resolution will not occur until the cutaneous reaction has fully settled.

Of 142 patients with Pseudomonas aeruginosa (PSA) ear infections, 88 (62 per cent) had chronic otitis media and 54 (38 per cent) external otitis. Following serotyping and pyocin typing of their bacteria, and relating the type to outcome, patients could be divided into three groups: (1) 120 patients who had no recurrence with isolation of only one PSA strain, (2) 13 patients who had recurrent infections and in whom the same PSA strain was isolated in repeated cultures, and (3) nine patients who had recurrent disease, but who had a change in their PSA strains. Most of the PSA strains isolated from patients in groups (1) and (2) were stable to pyocin, and resistent to gentamicin.

Patients in the first group were all cured initially by medical management. Of the nine patients in group (3) who had a different serotype on repeated cultures, medical treatment was successful in eight (89 per cent), but of the 13 patients in group (2) who had the same Pseudomonas aeruginosa serotype cultured, medical therapy failed in six (46 per cent) and mastoid surgery was required. Serotyping of Pseudomonas aeruginosa otitis may be helpful in predicting the type of management in patients who have recurrent infections.

Traumatic head injury is the principal cause of death and serious physical disability in adolescents and young adult. Hearing loss is a common sequela of head trauma. The results of pure tone and auditory brain-stem response (ABR) assessment of minor head injury revealed that 20 per cent of these cases showed impairment of hearing including both conductive and sensorineural heaing loss mostly in the high frequencies loss.

ABR findings showed a significant difference of absolute wave V latency and interwave (III-V) latencies at repetition rate 11.1 click/sec., and a highly significant difference at a repetition rate of 51.1 click/sec., compared with the control group.

In severe head injury, conductive hearing loss was found in only one case, in which a longitudinal fracture of the temporal bone was identified radiologically. No ABR could be recorded at a repetition rate of 11.1 click/sec. in either ear of this case; this patient died a few days later.

Three cases were found with a mixed sensorineural hearing loss; one of them showed a longitudinal fracture radiologically. ABR findings in two cases showed prolongation of wave V and I–V interwave latencies, and the third case showed absence of ABR recording.

In comatose patients, an ABR grading system is a more sensitive index of brainstem dysfunction than the simple division of normal versus abnormal ABR waves and interwave latencies. Presence or prolongation of wave V and interwave latency I–V even in one ear is of good prognostic value in the comatosed patient.

Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiologicaloutcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.

A number of minor variations to the configuration of the external ear are well recognized. This paper brings attention to one entity which is characterized by a small cartilaginous nodule or prominence arising from the posterior surface of the pinna and which we have named Quelprud's nodule. A prospective clinical survey of 208 patients attending an ENT clinic revealed that nearly one-third of the population studied possess this nodule. There was an equal sex incidence. The Quelprud's nodule was identified within families in a distribution which suggests an autosomal dominant inheritance with variable expressivity.