An alternative theoretical neuro-mechanical hypothesis is presented in the pathogenesis of middle ear effusion, along with a review.

The records of 120 patients who had undergone revision stapedectomy were analyzed to determine: (i) the causes of failure; (ii) how to prevent failure by taking precautions during primary surgery; (iii) hearing results; and (iv) possible identifying factors which might pinpoint those patients with a high risk of sensorineural deafness.

A review of these cases demonstrates that the results of revision stapedectomy are different from those of primary stapedectomy. The commonest cause of failure was prosthetic dislocation (30.8 per cent), followed by fibrous adhesions (18.3 per cent) and otosclerotic regrowth (14.1 per cent). First revision operations resulted in post-operative bone-air gaps of 15 dB. or less in 46.5 per cent of cases, much better than 25 per cent for second revisions. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB. or less in 89.5 per cent of cases.

The sensorineural loss occurred in 11.3 per cent or first revisions and in 16.6 per cent of second revisions, as compared to 1.3 per cent after primary surgery. “Dead ears” were encountered in 2.2 per cent of first revisions, as compared to nil in the primary group.

Thirty-six patients with bilateral symmetrical presbyacusis who reported a temporary improvement in the hearing of one ear following a Valsalva's manoeuvre were further investigated. Bone conduction and air conduction thresholds, middle ear pressure and middle ear compliance were measured before and after Valsalva's manoeuvre in the ears which had a subjective improvement in hearing following auto-inflation. Bone conduction thresholds remained unaltered in 66 per cent of ears while average air conduction thresholds varied by less than 5 decibels. Middle ear pressure was unchanged in over half the ears tested and in 81 per cent of the ears there was no change in middle ear compliance. There appears to be no simple explanation for the temporary subjective fluctuation in hearing reported by patients with presbyacusis.

A study was done on 41 patients to compare the use of the Walkman Mini-stereo system with different types of phones to mask tinnitus, by using music, or relaxation or different bands of noise similar to those generated by a tinnitus masker or pure tone, and it was found that the Walkman Mini-stereo system with any types of phone, was as effective, and more economic, both to patients and to the N.H.S., than traditional tinnitus maskers. It should be recommended for the management of tinnitus i n preference to the traditional tinnitus maskers.

Between 1974 and 1986, eleven of 114 patients undergoing trans-sphenoidal removal of pituitary tumours developed meningitis despite prophylaxis, usually with chloramphenicol. Nine patients had cerebrospinal fluid rhinorrhoea and one died. A variety of pathogens was isolated, including enterobacteria, and four of the eleven were resistant to the antibiotics given as prophylaxis. Enterobacterial meningitis was always associated with infection of the sphenoidal sinus involving the muscle graft or nasal pack (five cases), and removal of the muscle graft was necessary in three cases despite the use of appropriate antibiotics.

It has been widely held that peritonsillar abscess is a strong, if not absolute, indication for tonsillectomy, performed either immediately or after an interval of some weeks. A retrospective study of 48 patients is presented. It appears that age and the incidence of previous throat infections can be related to the likelihood of further problems and the need for operation.

The pain-relieving efficacy of naproxen and acetylsalicylic acid (ASA) in tonsillectomized patients was compared in a double blind parallel clinical trial comprising 83 patients, among whom 42 were treated with naproxen and 41 with ASA. The patients were treated post-operatively for two days with either naproxen suppositories 500 mg. twice, or ASA effervescent tablets 1000 mg. three times, daily.

The therapeutic gain was evaluated by recording the intensity of pain, reduced ability to open the mouth (trismus), consumption of supplementary analgesic (parcetamol), and pain-related sleep disturbances.

The statistical analysis of the results revealed no differences in pain intensity, consumption of additional analgesics or pain-related sleep disturbances in the two treatment groups. A considerable degree of trismus was demonstrated in most of the tonsillectomized patients. This reduced ability to open the mouth was gradually overcome in the naproxen group while it remained unchanged in the ASA group, however, no statistical significant difference could be demonstrated. Additionally, no significant positive correlation between pain intensity and trismus was proven. The pain-relieving effect, however, was unsatisfactory in both the naproxen and the ASA group, and clinical controlled trial studies of alternative analgetics in tonsillectomized patients are still to be encouraged.

Voice rehabilitation in the laryngectomy patient has been a major goal of reconstructive laryngeal surgery. 36 patients underwent laryngectomy with the creation of a phonatory neoglottis as outlined by Staffieri. In 13 patients good voice rehabilitation was achieved. In 23 patients who failed to develop voice production, altered swallowing function was the major problem.

Stricture formation may occur after pharyngolaryngectomy it less than one half of the circumference of the pharynx is available for primary closure. However, the alternative of total pharyngectomy with skin flap or visceral replacement carries with it a high mortality and morbidity rate. In an attempt to overcome these problems, a policy of patch grafting the paryngeal defect with a myocutaneous flap or segment of free vascularised jejunum has been adopted whenever a strip of pharyngeal mucosa greater than one centimetre in width remains after excision of the tumour. A good post-operative smallow has been achieved in all cases.

The ‘minitracheotomy’ i.e. an indwelling narrow-bore endotracheal tube which is inserted via the cricothroid membrane to provide access for the removal of secretions from the tracheobronchial tree following major thoracic and abdominal surgery, has recently been developed. In order to investigate whether its use may be injurious to the larynx, a prospective study was carried out assessing laryngeal function pre- and post-operatively in 14 patients, No permanent changes in laryngeal function were found and it was concluded that, when used for shourt post-operative periods, the larynx is not adversely effected.

Vasomotor rhinitis is a frustrating experience both for the consultant and for the patient. The purpose of vidian neurectomy is to destroy the secretomotor nerve supply to the nasal mucosa, the main indication being severe intractable non-atopic casomotor rhinitis.

A review of 208 cases which have undergone transnasal vidian neurectomy by diathermy coagulation in the last five years is presented.

The operation has proved worthwhile, the patients remaining symptom-free in 92 per cent of cases (longest follow-up 5 years). There have been on complications