The case notes of 841 subjects who had had ECochG carried out between January 1972 and December 1980, were examined and the results compared with PTA results in 263 cases in which these were available. ECochG was found to be a good predictor of peripheral hearing as long as its limitations were recognized, and some of these are discussed. BSER, which has similar limitations, was also found to be a good predictor of peripheral hearing, although slightly less sensitive, and sometimes gave additional information on the hearing loss and the clinical state of the patient.

Eight patients receiving prolonged treatment with gentamicin for bacterial endocarditis were monitored for possible ototoxicity using transtympanic electrocochleography as an adjunct to pure tone audiometry, vestibular function tests and serum gentamicin levels. An immediate effect of intravenous gentamicin on the cochlea, shown by changes in the whole nerve action potential and/or cochlear microphonic was recorded in seven patients, none of whom had experienced vestibular or auditory symptoms with gentamicin prior to testing. Two patients subsequently developed evidence of vestibular dysfunction, and a high frequency sensorineural hearing loss occurred in a third individual. There have been no previous report of the immediate effects of gentamicin on the human cochlea to date. The significance of these findings in routine clinical monitoring of ototoxicity is discussed in the light of clinical and animal evidence for the possible mode of action of aminoglycosides on the auditory and vestibular apparatus.

Active chronic otitis media affects 0.5 per cent of adults and has two main variants. The first is when there is a squamous epithelial retraction pocket or cholesteatoma. The second variant is when the disease is primarily of the mucosa of the middle ear and mastoid air-cell system. Classically a cholesteatoma is considered ‘unsafe’ because of the risk of complications, particularly intracranial infectioa Mucosal disease, on the other hand, is considered ‘safe’ because complications are thought to be rare. Surgery in the form of a modified radical mastoidectomy is considered to make active chronic otitis media ‘safe’.

A retrospective review of 26 consecutive brain abscesses considered secondary to active chronic otitis media revealed that a cholesteatoma was present in 12 (46 per cent), mucosal disease in 10 (38 per cent) and a modified radical mastoidectomy had been performed in four (15 per cent). Mucosal disease and a modified radical mastoidectomy should no longer be considered ‘safe’. However, the risk of developing an intracranial abscess from any type of active chronic otitis media is low, in the region of one in 3,500.

The previous use of ventilation tubes has been investigated retrospectively in a series of children whose ears had been operated on. Within a six-year period, 49 ears had a cholesteatoma documented, and in 14 of these a tube had been used. During the same period, 64 ears were operated on for chronic otitis media without cholesteatoma, and of these only three ears had been treated with a tube. This difference is statistically significant (p = 0.0004). A final conclusion is not possible from this information and more research is needed, but the study indicates the importance of a long-term follow-up of children who have been treated with ventilation tubes.

An open radical mastoid cavity presents a handicap to the patient If elimination of the cavity appears desirable, one should use an operative technique which does not incur the risk of a cholesteatoma redeveloping. In our experience obliteration of the cavity with non-resorbable methacrylate Sulfix-6 is the best way to achieve this. The arguments in favour of this view are presented and the operative technique is described.

One hundred and thirty-nine patients with advanced head and neck cancer were treated with a combination of vincristine, bleomycin, methotrexate with a folinic acid rescue, 5-fluorouracil and hydrocortisone given over 24 hours, as initial therapy on days one and 14 prior to conventional local therapy on day 28. One hundred and thirty-six patients were assessed for chemotherapy response on day 28. Ninety-one patients (67 per cent) had an objective response and 45 (33 per cent) were classed as non-responders, although 13 had a minimal (20–30 per cent) response. The complete remission rate following local therapy was significantly greater in chemotherapy responders (76 per cent) than in non-responders (54 per cent) p<0.05. Toxicity was minimal, provided standard medical precautions were observed, and 87 patients (63 per cent) reported no side-effects. There was 100 per cent patient compliance. Sex or histological grade did not significantly influence response to chemotherapy. Oral cavity or nasopharyngeal tumours responded better than other sites (p<0.05). Patients under 49 were more likely to respond to chemotherapy than older patients (p<0.01). Survival data are available for a mean follow-up time of 48 months (range 12–78 months). Chemotherapy responders have a longermedian survival than non-responders, 33 versus 20 months (p<0.05). Patients who achieve a complete remission after local therapy live significantly longer than those with residual disease, median durations of survival being 52.4 and 7.8 months respectively (p<0.001). Actuarial analyses indicate that at five years 46 percent of patients in complete remission are alive, compared with only 9 per cent with residual disease. Since chemotherapy responders are significantly more likely to achieve a complete remission than non-responders (p<0.05), objective response to this schedule of chemotherapy is a good prognostic sign.