The planum semilunatum is located on the lateral side of the crista ampullaris of thesemicircular canal. With regard to the functions of the planum semilunatum, some researchers assume the existence of secretory activity based on the microstructural features observed in isotopic experiments. In the present study, in order to confirm the existence of an immunological mechanism in the ampulla of the semicircular canal, the distribution of immunoglobulins in the semi-circular canal of guinea pigs was investigated immunohistochemically. Positivity of IgG wasobserved in the constituent cells of the planum semilunatum or beneath the basement membrane ofthe cells.It is concluded that ample IgG, which is an important constituent of the body fluids, is collected within this region. The planum semilunatum containing such ample amounts of IgG might be involved in the immunological mechanism operating in the ampullar of the semicircular canal.

The distribution of carbonic anhydrase isoenzymes (CA) was analyzed in the developing endolymphatic sac (ES) of the mouse embryo and human fetus using immunohistochemical method. The primordial ES epithelium was labelled with CA I and CA II, but was weakly labelled with CA III and CA V. In the thirteenth and fifteenth gestational day (GD) mice, the ES epithelium was positive for CA I and CA II. After seventeenth GD, the ES epithelium was however weakly positive for CA I and CA II. In the 11 and 12 week old human fetus, the ES epithelium was strongly labelled with CA I and CA II. In the 16 week old human fetus, the ES epithelium was however weakly positive for CA I and CA II. These results suggest that the fetal ES has an activity of CA and plays a role in the otoconial formation especially in the early stage during evolution.

In our histological examination on 42 ears (auricles) which were taken from 18 fetus and three adults, the intracartilaginous fibrous tissue with blood vessels and lymphatics were found in 12 ears and interruption of the auricular cartilage in 22 ears. The intracartilaginous connective tissue with blood vessels and lymphatics were linked together with the connective tissue outside the auricular cartilage in other sections. These findings support the hypothesis of congenital embryonic dysplasia as the origin of the formation of pseudocyst of the auricle.

A simple and effective speech in noise test is described with clinical findings for patients with normal hearing, cochlear and retrocochlear pathologies and auditory dysacusis. The test utilizes material readily available in Audiology and ENT Departments. It was possible to obtain useful diagnostic information in patients who complain of hearing loss, but who demonstrate normalaudiometric thresholds and normal speech in quiet discrimination.

Epithelial cells were obtained by swabbing the posterior wall of the nasopharynx (NPH) of 15 patients (age one to 6 8/12; years; eight males, seven females) undergoing ENT-surgery under general anaesthesia for otitis media with effusion (OME). Individually matched, ear healthy children served as controls. Bacteria attached to the non-ciliated cells were calculated according to a method described. Furthermore, quantitative and qualitative bacteriological analyses were performed on samples obtained from mucoid middle ear effusion material as well as from the NPH. All patients and controls harboured middle ear pathogens (S. pneumoniae, H. influenzae, B. catarrhalis, or S. aureus) in the NPH. Only 33 per cent of the patients harboured middle ear pathogens in the middle ear effusion and the same pathogen was invariably found in the corresponding NPH Attachment of bacteria to the non-ciliated cells of the NPH diminished significantly with growing age in the ear healthy control group but not in the OME group. OME is closely correlated tothe presence of middle ear pathogens in the NPH and to attachment of bacteria to the epithelial cells in the NPH.

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique.

In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.

A new surgical technique for the treatment of cholesteatoma is reported. The technique involvesautoexclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small.

The technique allows visual post-operative control of the attic and tympanic membrane. There isno visual access to the mastoid cavity which, however, is the most unlikely site for occurrenceof a residual cholesteatoma.

The proposed technique was applied to 102 patients and both the anatomic and functional resultsobtained are reported.

This paper reports a new procedure used successfully in the reconstruction of 12 radical mastoid cavities in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. A composite pedicled flap composed of temporalis muscle and its fascia attached along one border, based posteriorly, is rotated in to the radical cavity. The muscle is used to obliterate the cavity and the fascia is hinged forward as a tympanic membrane graft.

Thirty-two composite resections were carried out in the Department of Otolaryngology at Groote Schuur Hospital for oral and oro-pharyngeal squamous carcinoma over the 10-year period, 1977–1986. Three patients were lost to review but all others were followed up to death or to five years. Twenty-seven patients underwent surgery as their primary procedure and five for recurrence after primary radiotherapy. The overall survival was 16 patients at three years and eight at five years. Only one of the five patients who underwent salvage surgery after failed radiotherapy was alive at five years and all five experienced serious postoperative complications. All thosesurviving over five years had had either N0 or N1, disease at the time of presentation for surgery.

During a 10 year period 30 patients with carinoma of the soft palate were treated. There were 22 cases in stages I and II. A curative dose of irradiation was used in 25 cases, fourof whom required surgical salvage. Another five cases were treated by a combined modality of surgery and postoperative radiation. Seven cases had nodal metastases. A mean two-year disease-free survival of 83 per cent was obtained. The probability of five-year disease free survival was 65 per cent.

Fifteen Japanese patients with Wegener's granulomatosis (WG) were evaluated according to their lymphocyte subset abnormalities. Two colour immunofluorescent flow cytometry was used to distinguish the lymphocyte subset alterations. WG group showed a decrease in the percentage of CD4+ cells and the increase of CD8 + cells. Within the NK cell family, the functionally unidentified CD8 +57 + cells were markedly elevated. The disproportion of thelymphocyte subsets (CD4 +↓ CD8 +57 +↑) were similar to those of Acquired Immunodeficiency Syndrome (AIDS) and AIDS relating complexes (ARC). To assesssilent infection of Human immunodeficiency virus (HIV), the polymerase chain reaction (PCR) wasdone for all patients to selectively amplify specific HIV proviral DNA sequences in peripheral blood mononuclear cells, HIV-1 proviral DNA was not found in any patients but these changes of WG might suggest a possible adaptive response to unknown viral infection.

We present a retrospective study of 106 patients with branchial cleft and pouch anomalies who presented to the Hospital for Sick Children between 1948 and 1990. The relevant embryology of the branchial apparatus is summarized and a theoretical description of individual anomalies given.

Second branchial cleft sinuses were the most common anomalies, and the majority were managed simply, with adequate excision and a low recurrence rate. Five cases of first branchial cleft anomalies are presented, emphasizing the delay in diagnosis, the need for complete excision to prevent recurrence, and for a parotidectomy incision to protect the facial nerve from damage. The two third branchial pouch anomalies presented with a cystic neck swelling, one with recurrent infection and discharge, and the other with stridor. In both, the diagnosis was made at operation. The single fourth branchial pouch cyst was an unexpected finding in a patient with stridor.

Serious complications resulting from the use of fast neutrons to treat head and neck malignancies are reported in 38 patients. The average interval between treatment and onset of complications was 5.5 years. Significant airways obstruction, requiring a tracheostomy, occurred in two patients, and a gastrostomy or pharyngostomy was performed for intractable dysphagia in six. Eight patients developed osteoradionecrosis; carotid artery rupture occurred in three patients following surgery for residual or recurrent disease.

Our experience suggests that complications following fast neutron therapy for head and neck tumours are more severe, more common and occur after a longer time interval than those seen following conventional radiotherapy. Subsequent surgery in the irradiated area is compromised by severely impaired wound healing. When radical surgery is necessary for residual or recurrent disease the entire volume of irradiated tissue must be removed if healing is to be achieved.

The 10-year follow-up of patients in a clinical trial involving the comparison of treatment by three fractions per week versus five fractions per week in radiotherapy of squamous carcinoma of the larynx and hypopharynx has now been completed. The trial involved an intake of 734 patients between 1966 and 1975. No statistically significant differences have been found between the two trial arms in terms of overall survival, age corrected survival, local recurrence, laryngectomy-free rates or effects on the normal tissues. Local recurrence was found in 320 of the 713 evaluable patients (45 per cent). Salvage laryngectomy was performed in 151 of the 320 patients with recurrence (47 per cent). Survival at 10 years for all node negative patients was 50 per cent in those patients without primary recurrence, compared with 40 per cent in those undergoing salvage laryngectomy.

The Groningen valve was first used in Sheffield in 1986 in a patient who underwent laryngectomy for malignant disease. Since then a further 21 patients have made use of this device, 17 of whom underwent insertion at the time of surgery. All patients were male, two patients have since died and the median length of follow-up to date has been 22.0 (range 2–41) months.

Prostheses were replaced mainly under general anaesthesia if they leaked or resulted in difficult phonation. A total of 73 valve insertions have been performed with a median time of 4.0 (range 0.25–27) months between each. of the 15 men in whom the prosthesis is currently in use, speech was generally good-excellent.

The Groningen valve provides a highly acceptable means of obtaining vocalization after laryngectomy in the patients in this series.

Small foreign bodies lodged anteriorly in the tympanic sulcus are usually not visible, due to the curve of the external ear canal. Such objects can be seen with the aid of an otomicroscope and micromirror or with an endoscope, and removed by irrigation. If irrigation fails, epithelial migration on the tympanic membrane may remove lodged foreign bodies, although this may take months. Our new method, which uses water to locate small objects lodged in the tympanic sulcus, includes irrigation of the ear, adjustment of the water level to the middle curve of the external ear canal, and use of the water surface as a concave lens, making the tympanic sulcus visible. With otomicroscopy a curved ear probe can then be used to remove lodged foreign bodies from behind the curve.

Four male patients with pseudocyst of the auricle were successfully treated with oral corticosteroids. This condition is an asymptomatic, non-inflammatory, cystic swelling, usually located in the scaphoid or triangular fossa of the anti-helix which if untreated, leads to deformity of the pinna. All successful methods of treatment described in the literature so far have been invasive. All four patients in the above series responded to oral steroid therapy alone.

Observations based on two contrasting cases of myringitis bullosa haemorrhagica indicate that tympanosclerosis involving the tympanic membrane may have a significant effect on the clinical course of the disease. The evidence suggests that the bullae associated with the condition arise from the epidermal layer of the eardrum.

Patients who present with a unilateral non-tender bony swelling in the mastoid region without any clinical evidence of middle ear infection could be diagnosed as having a fibrous or bony lesion affecting the temporal bone. In such cases, if there is radiological evidence of large lucent area in the mastoid antrum without any bony dehiscence one should keep in mind in the differential diagnosis a mega antrum in addition to congenital cholesteatoma and eosinophilic granuloma. A large lytic lesion in the mastoid segment of the temporal bone with an intact tympanic membrane therefore presents a diagnostic dilemma. A case of an unusually large mastoid antrum in an young adult with no middle ear suppuration and a cosmetically unacceptable swelling behind the ear is presented.

The operation of chondroplastic graft augmentation rhinoplasty was described in a previous paper by the present author. Seventeen months following one such clinically successful operation, the opportunity was taken at a subsequent nasal procedure to remove a small portion of the original graft and submit this to histological examination. The results of this confirm the viability of a graft harvested and implanted by this technique.