The intranasal distribution of aerosol from a metered dose inhaler has been assessed using a radiotracer technique. Inhalers were prepared by adding 99Tcm-labelled Teflon particles (simulating the drug particles) to chlorofluorocarbon propellants, and scans of the head (and chest) taken with a gamma camera. Ten healthy subjects (age range 19–29 years) each performed two radioaerosol studies with the inhaler held in two different ways: either in a single position (vial pointing upwards) or in two positions (vial pointing upwards and then tilted by 30° in the sagittal plane).

The vast majority of the dose (82.5 ± 2.8 (mean ± SEM) per cent and 80.7 ± 3.1 per cent respectively for one-position and two-position studies) was deposited on a single localized area in the anterior one-third of the nose, the initial distribution pattern being identical for each study. No significant radioaerosol was detected in the lungs. Only 18.0 ± 4.7 per cent and 15.4 ± 4.1 per cent of the dose had been removed by mucociliary action after 30 minutes, and it is probable that the remainder had not penetrated initially beyond the vestibule. Since the deposition pattern was highly localized and more than half the dose probably failed to reach the turbinates it is possible that the overall effect of nasal MDIs is suboptimal for the treatment of generalized nasal disorders.

Thirty-four Menière patients (43 ears) were treated in an underpressure chamber. Békésy audiometry and impedance audiometry were performed immediately before and after the exposure to underpressure. A hearing gain of more than 10 dB. was found in 19 per cent of the ears (8/43). In five ears this improvement lasted for a few days. Only one patient (2 per cent) reported a relief of tinnitus. In 9 out of the 30 patients (30 per cent) with recent vertiginous attacks a positive subjective effect on the vertigo was obtained.

Measurements of nasal airways resistance in normal subjects have shown a significant difference between values obtained in the two respiratory phases. Higher overall values are found during expiration in both the unprepared and decongested nose but these differences fail to maintain statistical significance after application of a decongestant. This indicates that the phase of respiration in which measurement is made must be routinely recorded especially when measurement is made without decongestant, and comparisons of data made only with recordings from equivalent parts of the nasal cycle.

We have successfully used fibrin glue to avoid operative nasal packing in 30 cases of septal surgery. Avoiding a nasal pack is not only more acceptable to the patient but may also reduce hospital stay. Analysis of our results showed some minor short-term complications but initial post-operative septal deviation tended to resolve spontaneously. Transient oedema and hyperaemia occurred in 37 per cent of cases and may represent an allergic response despite few classical allergic reactions having been reported.

Twenty patients, 10 allergic and 10 non-allergic, with chronic hypertrophic rhinitis and presenting mainly with bilateral nasal obstruction were subjected to sub-mucosal diathermy of their inferior turbinates. There was significant post-operative improvement clinically, histopathologically and histochemically in the non-allergic group, while the improvement was less obvious in the allergic cases. The post-operative clinical improvement as regards rhinorrhea and sneezing was not as marked as that for nasal obstruction. Evaluation of the results showed that sub-mucous diathermy of inferior turbinates is a good line of treatment for cases of chronic hypertrophic rhinitis, with better results in the non-allergic group of patients.

Antroscopy has been shown to have a significant role to play in the management of chronic sinus disease. A technique, performed via the inferior meatus, is described which has been used successfully in 103 patients under local anaesthetic. Particular attention has been paid to the practical problems and pitfalls which may be encountered and how they may be overcome. Vasovagal symptoms were the commonest adverse effect, occurring in 15 patients; otherwise the associated morbidity was encouragingly low. It is concluded that antroscopy performed with a good technique can be a rewarding procedure suitable for use in the outpatient department.