This paper discusses the possibility of a localized peripheral origin of tinnitus. A working hypothesis is that tinnitus represents either aperiodic or periodic hyperactivity in the spontaneous activity of nerve fibers originating from a restricted place on the basilar membrane. The limited physiological data available support both hyperactive and hypoactive nerve fiber. Psychophysical data are not easy to interpret. Subjective descriptions and category scaling are too dependent on individual experience. Pitch matching can be reliable, but cannot distinguish between peripheral or central tinnitus. In one experiment we compared the masking of tinnitus to the masking of a pure tone, where the signal frequency and level were obtained from the tinnitus pitch and loudness matching. The results indicate that the broad tinnitus masking patterns are not typically due to the poor frequency resolution observed in sensorineural hearing loss. However, in a few subjects there was some correspondence between the shape of the tuning curve and the tinnitus masking pattern. In another study, we masked tinnitus with narrowband noises of different bandwidths. In some patients, there was a ‘critical bandwidth’ effect; wider masker bandwidths required greater overall sound pressures to mask the tinnitus. We conclude that the results from these studies taken together indicate that there are different types of tinnitus, some of which may have a localized peripheral origin.

Five cases of post-tonsillectomy quinsy are presented, usually associated with tonsillar remnants. Foot of these had no pus and one did, but the clinical picture was the same. Hence, if tonsillectomy is performed to prevent further quinsies, it must be careful and complete.

Otolaryngological complications occurred in 5 per cent of 467 patients with infectious mononucleosis admitted consecutively to the ENT-department during the period 1 April 1969 to 30 June 1981. Four patients had peritonsillar abscess and five patients developed potentially lethal obstruction of the upper airway. Such complications require intervention and, as the latter condition probably is the most frequent fatal complication of IM, we find it important that patients with even slight respiratory embarassment in infectious mononucleosis should be observed and treated in an ENT-department.

The subjective nature of tinnitus is not the only feature which imposes difficulties upon the identification of tinnitus. The patients who must provide information about their tinnitus are greatly handicapped in this task and for the simple reason that there is very little vocabulary available to them. Thus it is not only important that the clinician listen very carefully to the patient but it is increasingly important that standardized tests be used to identify, measure and classify tinnitus.

Following radiotherapy for squamous carcinoma of the larynx, it may be impossible to differentiate occult persisting tumour from irradiation effects, possibly with chondroradionecrosis, even after repeated biopsy. In seven of the cases presented, post-treatment laryngectomy failed to provide histological evidence of residual or recurrent carcinoma, which clinical examination has indicated. None-theless, total laryngectomy was performed, subsequently revealing tumour in five of the seven excised larynges. The two tumour-free larynges were associated with cervical metastases. The clinical indications of persisting tumour, the factors compromising post-irradiation evaluation and the role of diagnostic aids are discussed.

The authors have studied the anatomy of the external branch of the superior laryngeal nerve in its entirety on 40 fresh cadavers, and they have drawn the following conclusions: the nerve ramifies from the vagus immediately below the nodose ganglion or in the ganglion itself. The nerve splits into two branches approximately 1.5 cm below the ganglion nodosum. In four cases, both branches originated from the vagus itself. In one case, anastomosis of the external branch of the superior laryngeal nerve with the recurrent nerve was found. The external branch of the superior laryngeal nerve is not usually severed at supraglottic laryngectomy but the nerve is at risk during neck dissections, resection of Zenker's diverticula and thyroidectomy. An accurate knowledge of its course should reduce the incidence of injury to the branches of the superior laryngeal nerve during surgery.