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.

The typical workup for tinnitus patients includes a medical examination, an audiometric assessment, a tinnitus evaluation and finally management of the patient. The means of managing the patient can involve drug therapy, biofeedback or masking. However, regardless of the treatment of choice, most patients undergo, at least to some degree, parts of the three initial evaluations. Our task is to describe, in part, the use of the audiogram in managing the tinnitus patient.

The audiometric work-up for the tinnitus patient does not differ greatly from the typical audiometric assessment performed for diagnostic purposes or a hearing aid evaluation. This procedure includes pure tone testing (air conduction and bone conduction), impedance audiometry and speech testing. Special auditory tests are performed only when additional diagnostic information is indicated. The only major difference in the procedure involves presenting pressure through the probe tip without the accompanying probe tone. This gives the clinician an indication as to whether or not atmospheric pressure changes might affect the patient's tinnitus.

Benign tumors of the larynx are rare lesions and seldom encountered by radiologists. They usually are small, most commonly being diagnosed by indirect or direct laryngoscopy. A case of a large benign lipoma arising from the larynx which was visualized radiographically is described. A definitive diagnosis, however, was only possible following surgical excision of the lesion.

A 55-year-old man with symptoms of hearing loss, balance disturbance, and facial weakness was treated by translabyrinthine eighth cranial nerve trans-section. The patient also had a history and physical signs of chronic alcoholism and peripheral polyneuropathy. Results of laboratory tests revealed concomitant nutritional deficiency. Histopathological examination of the eighth nerve showed extensive degeneration of both myelinated and unmyelinated nerve fibers in both cochlear and vestibular divisions. Light and electron microscopic features of the degenerative process were compatible with previously described pathology of experimentally induced Wallerian-like degeneration. Alcoholic neuropathy as the cause of hearing loss and balance disturbance—and probably facial paresis—is suggested.

A patient presenting a chief complaint of tinnitus poses an interesting problem to the clinician. Since tinnitus is a symptom and not a disease, our job as diagnosticians is to determine if the tinnitus is associated with hearing loss and to screen for retrocochlear involvement. At Temple Hospital, a patient with tinnitus is examined like any other patient. A thorough history is taken and a complete audiologic and otologic evaluation is done. Patients are then referred for brain-stem-evoked response audiometry (BSERA) according to the protocol shown in Table I. Patients are referred if they have unilateral hearing loss, unilateral or bilateral tinnitus, tinnitus uncorre- lated with hearing loss, vestibular complaints, asymmetric hearing loss, and progressive hearing loss. In addition, screening X-rays and/or blood tests might be ordered. Plesiotomograms of the temporal bone are taken to screen for the presence of a space-occupying lesion in or around the internal auditory meatus.