The objective of this paper was to determine the effectiveness of combined steroid-antimicrobial therapy for otitis media with effusion (OME) of sufficient duration to justify tympanostomy tube insertion.

A consecutive sample of 122 children with bilateral OME of at least three months duration, or unilateral OME of at least six months duration, despite treatment with one or more beta-lactamase stable antibiotics was studied. The treatment group received prednisolone plus a beta-lactamase stable antibiotic for 10 days, with responders receiving an additional six weeks of chemoprophylaxis. The control group received no medication. The child's caregiver decided which group the child should be in.

Resolution of effusion in all affected ears occurred in 32 per cent of steroid-treated children and in 2 per cent of controls (p<0.001) at three to four weeks post-therapy. Relapse of effusion occurred in over 40 per cent of initial responders within six months, reducing the final resolution rate to 25 per cent (95 per cent CI: 15–36 per cent).

It was concluded that treatment with oral steroids should be considered in selected children with chronic OME prior to surgical intervention. One in every four children whose caregiver consents to this therapy may avoid or postpone surgery for at least six months.

Retraction pockets of the pars tensa in children can result in erosion of the ossicles leading to hearing loss and eventually cholesteatoma formation. Several different types of treatment for the more severe grades of retraction pocket have been described. The aim of this pilot study was to assess the outcome following simple excision and ventiolation tube insertion of grade II, III and IV retraction pockets of the pars tensa. The eardrums were grades according to Sadé's classification (1979).

There were seven grade II and four garade III ratractions. Ten eardrums healed completely in a mean time of 3.6 months (mean follow-up 16 months) and there was one residual perforation. Two retractions recurred and both of these were only grade I. Clinically, an improvement in hearing was reported in seven children (eight ears) and the average air conduction threshold gain for these patients was 16 dB. A larger prospective study is currently underway.

A straight, vertical post-aural incision for the ‘Cochlear’ multichannel cochlear implants has been evaluated in 52 patients (20 adults and 32 children). Nineteen of the children were under three years of age and five of these were under two years of age.

The 7cm long incision is placed approximately 3 mm behind the post-auricular crease and runs from the tip of the mastoid to a point 3 cm above the superior attachment of the pinna. The incision heals within several days.

Because the incision is straight interruption of the blood supply to the flaps raised is the least possible. This also minimizes the possiblity of scalp necrosis and impaltn exrusion. The likelihood of infection is reduced by the small size of the incision, minimal soft tissue dissection and small amount of dead space. Rapid healing has occurred in all cases despite infection in one.

This study examines the advantages and internal consistency of an open-ended queionnaire (Benefit problem questionnaire), over the Tinnitus questionnaire used by Jakes et al. (1985) in the auditing of a Stress management Programme.

This Tinnitus quesitionnaire showed very little difference pre- and post-treatment, while the Benefit/problem questionnarie showed good improvement over a number of variables. This included some of the more traditional orthogonal values of tinnitus complaint. The clinical assessment made blindly and over different tikme scale to the Benefit/problem questionnaire matched these positive results quite closely.

Type 2 neurofibnormatosis is a dominantly inherited disorder in which the great majority of sufferes develop bilateral vestibular schwannomas. In a UK study of 183 individuals from 112 families we have previously shown a fairly similare disease course within families, but quite marked inter-familial variation. We have confirmed an increase in severity when the gene is inherited from an affected mother, but evidence that women are more severely affected than men is lacking. Age at onset of symptoms, of deafness and at diagnosis are idential for the entire dataset and for a comparison of 10 male/female sibling paries. Only three out of 42 pregnancies in symptomatic women were accompanied by reversible worsening in symptoms due to vistibular schwannomas. Of 328 consecutive cases of unilateral vesitibular schwannoma, there was no significant difference in the sex ratio or size. There now appears to be little evidence for a female hormonal effect on vestibular schwannomas. However, females with type 2 neurofibromatosis have significantly more meningfiomas.

Following a lesion in the vestibylar system visual, proprioceptive and residual vestibular information is integrated by the brain, to enable a patient ot attain equilibrium. The basis of vestibular rehabilitation is to encourage these adaptive and compensatory mechanisms. Another form of rehabilitation is to provide some form of mechanical aid, and walking sticks are often used for this purpose in patients with balance disorders.

There are no reported studies objectively assessing the use of walking sticks in patients with balance disorders. In this study we used the Sway Weigh balance patform (Raymar) to determine the efficacy of a walking stick in 25 patients with peripheral vistibular balance disorders. Patience were tested with their eyes opened and eyes closed whilst they were standing on a flat surface and on an air-filled bed (to alter limb proprioeption) on the Sway Weigh balance platform. All the tests were carried out with, and without, a walking stick. The results demonstrate that a walking stick significantly reduces lateral body sway in patients with peripheral vestibular balance disorders.

The introduction of a topically active H1-antihistamine nasal spray Azelastine, has given an extra dimension in the management of allergic rhinits. The drug acts rapidly and avoids the sustemic adverse effects of antihistimines. An objective prospective study was performed to detect the effect of Azelastine nasal spray on nasal airway resistance. Twelve healthy adult volunteers with no rhinological problems were included in the study. Nasal cavites were sprayed with 280 μg (two puffs) of Azelastine nasal spray and the nasal airway resistance was measured with anterior rhinomanometry at intervals of 30 minutes for up to two hours. Our study has shown statistically significant increase in the total nasal airway resistance following the use orf Azelastine nasal spray in the absence of a subjective change in nasal airway resistance. There are substances when inhaled which can cause subjective improvement in nasal airway patency without changing the measured nasal airway resistance. However this medication gives no subjective change in nasal airway patency in spite of increasing nasal airway resistance.

The differential diagnosis of stridor in an infant depends on a careful history and examination, followed by radiological and endoscopic investigations. Currently a chest, lateral neck and antero-posterior, high kilovolt (Cincinnatti) view radiographs in association with a diagnostic barium swallow are performed prior to the definitive diagnostic procedure of microlaryngobronchoscopy.

Our impression was that some of the routinely ordered radiological investigations were of limited value in the differential diagnosis. We undertook a retrospective audit study to determine the value of radiological investigations in the pre-endoscopic assessment of infants with stridor. The radiological and endoscopic information of 100 infants presenting over the three-year period 1991–1993 at Great Ormond Street Hospital, London (a tertiary referral centre) was collected.

It was found that only five out of 65 barium swallow investigations performed had consistent positive findings at diagnostic microlaryngobronchoscopy. The lateral neck and Cincinnatti views identified many of the more gross pathologies of the larynx and trachea e.g. the space occupying lesions, which occur infrequently. The more common diseases e.g. laryngomalacia or subglottic stenosis are rarely identified radiologically.

Our results confirmed that radiology had a limited screening role and that in a child presenting with stridor the initial radiological assessment should be a chest radiograph with further imaging and a barium swallow only if an abnormality is found at microlaryngobronchoscopy.

We present our experience in the surgical management of 21 snorers, utilizing a new approach designed to stiffen the palatal musculature, without compromising its function. This was achieved by using a punctate patterna of intrapalatal diathermy to achieve fibrosis within the palate and hence the requisite stiffening. The initial results of this procedure are encouraging showing a subjective improvement in snoring in 85.7 per cent of patients and an increase in sleeping in the same room as their partner every night, from 14.3 per cent pre-operatively to 57.1 per cent post-operatively.

The usefulness of fine-needle aspiration cytology (FNAC) in the diagnosis and treatment of submandibular gland lesions is not well known. The 210 FNACs taken from submandibular gland lesions at Turku University Central Hospital between 1984 and 1991 were reviewed. Of these FNACs, 78 samples from primary lesions were confirmed histologically. Within this subset 10 FNACs were taken from benign neoplasms, all of which were correctly classified (sensitivity 100 per cent; specificity 88 percent). Only four of the 14 FNACs from malignant lesions were cytologically considered malignant (sensitivity 29 per cent). On the other hand, four FNACs raised a false suspicion of malignancy (specificity 6 per cent). Out of 54 FNACs from non-neoplastic lesions 43 were correct (sensitivity 80 per cent; specificity 63 per cent). There were 104 patients (123 FNACs), who had not been operated on: the follow-up of these patients shows that in this subset of FNACs there were no false malignant but probably one false benign finding (1 per cent). We conclude that FNAC can offer valuable information about the type of the submandibular gland lesion, but the decision of operative and other treatment should not be based solely on the result of FNAC.

The relationship between upper and lower respiratory tract infections has been demonstrated previously, although the effect of chronic infection of One tract on the other has not been well studied. This work analyses the broncho-alveolar lavage fluid of patients with chronic purulent rhino-sinusitis and reveals and increase in the neutrophil nitro-blue tetrazolium dye reduction test positivity provides evidence for increased phagocutosis to compensate for the increased contamination of the lower respiratory tract.

A simple, safe and effective procedure of improving the diagnostic accuracy of nasopharyngoscopy is described. It is most useful for the exposure of the hypopharynx, especially in the elderly patient.

Aneuroysm of the intrapectous carotis artery is an extremely rare and potentially serious occurence that presents diagnostic and therapeutic difficulties. Such aneurysms may follow trauma, atherosclerosis, mastoid surgery or most commonly can represent a developmental abnormality. We present the case of an 18-year-old female with a short history of recurrent left-sided otalifa and epistaxis who underwent successful endovascular ballon entrapment of a left intrapetrous carotid aneurysm.

Maxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.

Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. We present a case of a previously fit. 73-year-old, male with upper airway obstruction secondary to a floppy epiglottis. We describe a simple method of treatment without the need for partial or total excision of the epiglottis or trecheostomy.

We report two cases of recurrent layngeal papillomatosis in women who subsequently developed squamous cell carcinoma as they approached the climateric. The role of human papilloma virus (HPV) and oestrogen metabolism is outlined. The use of indoles from cruciferous vegetables is also discussed.

Children with subglottic stenosis present a challenging problem to otolaryngologists. In many cases, a tracheostomy is necessary to safeguard the airway, but morbidity and mortality in the tracheostomized child may be significant. Therefore attempts to improve the airway by endoscopic means are often made; unfortunately, these have a variable success rate. Recent encouraging results in the use of balloon dilatation for subglottic stenosis led us to the successful use of this technique in a child whose stenosis had not responded to conventional endoscopic techniques. The reasons for the success are discussed.

A 67-year-old man with an enlarged left tonsil underwent a tonsillectomy for the suspicion of malignancy. He had had a dental extraction six months earlier. Clinical and histopathological investigations established the diagnosis of primary tonsillar tuberculosis.

Schwannoma of the posterior pharyngeal wall, in a 36-year-old male patient is presented demonstrating the asymptomatic nature of the tumour (which is peculiar to schwannomas). The tumour gradually increased in size, destroyed the body of the third cervical vertebra but remained asymptomatic. The patient only presented to hospital when the tumour obstructed the airway, because of its large size.

A case of recurrent abscess on the left anterior neck due to a left piriform sinus fistula is presented. It is known that a piriform sinus fistula may cause acute suppurative thyroiditis, and also that it induces the recurrent anterior cervical abscess described in this case. Here, we suggest that barium swallow is an important aid to diagnosis cases of recurrent cervical abscess.