Medical audiologic evaluation of the patient presenting the primary symptom of tinnitus is an attempt to objectivize the subjective complaint. Tinnitus classification depends upon diagnostic information obtained from the medical-audiologic assessment and includes multi-disciplinary inter- pretation of these data by the audiologist and the otologist working as a team.

Test data obtained from 112 cases, 64 males with a mean age of 56.0 and 58 females with a mean age of 48.9 years, referred for medical-audiologic assessment with the chief complaint of tinnitus, indicate that site of lesion obtained audiologically, site of lesion obtained otologically, and site of lesion of the tinnitus need not necessarily be identical (Table I). In our clinic, medical-audiologic assessment for the complaint of tinnitus consists of cochleo-vestibular evaluation and tinnitus evaluation.

Briefly, cochleo-evaluation consists of pure-tone audiometry; speech audiometry, including speech reception threshold and speech discrimination testing; tone-decay testing; short-increment sensitivity index; impedance audiometry consisting of tympanometry, acoustic reflexes (contralateral and ipsilateral) reflex-decay testing, and the Metz test for recruitment.

This paper concerns the results of 200 patients with tinnitus as a primary symptom. Sixty-nine patients formed a pilot study and are not discussed here. Full data are available on 131. The object was to examine each patient in as great detail as possible to see if any significant correlation could be found between different factors involved in their tinnitus. A previous study by Reed (1960) failed to show significant correlation between the variables analysed.

All data were recorded on specially prepared questionnaires. The first involved details of occupation, noise exposure, previous illness, family history of deafness or tinnitus, exposure to ototoxic drugs, details of previous ear disease, hearing aid experience, hearing problems and the incidence of problems at home and at work. The second questionnaire asked specific questions about the tinnitus, particularly its subjective loud- ness rating, variability and factors affecting it. The third questionnaire was used for recording details of otological and audiometric assessment, including the subjective synthesis.

This is a report of a 32-year-old woman who presented with a hidradenoma papilliferum of the external auditory canal. The lesion bears a marked histologic resemblance to vulvar hidradenoma papilliferum and to intraductal papillioma of the breast and, as in the latter neoplasm it may malignancy. However, these are benign tumours and warrant only local resection. Clinical symptoms related to obstructure of the external ear and some hearing loss.

This report emphasizes again the variety of neoplasms which occur under the generic name of ceruminoma. It is recommended that each of these tumours be classified according to its characteristic histologic features and that the term ceruminoma, as used at present, be abandoned.

Adenomas of the ceruminous glands located in the external auditory canal are rare tumours (Batsakis et al., 1967; Cankar and Crowley, 1964; Pluec, 1977). About forty cases have so far been reported in the literature (Dehner and Chen, 1980). The histological classification of these benign ceruminous tumours is similar to that used for sweat gland tumours in other locations (Neldner, 1968; Pahor and O'Hara, 1975; Wetli et al., 1978).

The most common type demonstrates features of glandular or tubular adenoma with epithelial structures which are similar to those of normal apocrine glands (Althaus and Ross, 1970; Anagnostou et al., 1974; Leitner, 1952; Camkar and Crowley, 1964). The second type of benign ceruminoma is the pleomorphic adenoma (Mark and Rothberg, 1951; Smith and Duarte, 1962; Pahor and O'Hara, 1975). Its histogenesis from ceruminous or ectopic salivary glands is still debated.

The purpose of this paper is to report still another type of benign ceruminoma, namely the hidradenoma papilliferum which so far has only been mentioned as a theoretical possibility (Dehner and Chen, 1980).

A Retrospective review of 45 patients with advanced squamous cell carcinoma of the head and neck treated by a combination of initial chemotherapy (Price and Hill Schedule A) followed by radiotherapy is presented. The regime produced excellent immediate palliation with a tumour control of 50 per cent, and a disease-free survival of 33 per cent at one year and 27 per cent at two years. Treatment morbidity was minimal in an aged patient group.