Forty-five patients who were to undergo elective urological operations were evaluated. In the pre-operative period and on the third or fourth post-operative day audiometry was performed. Epidural anaesthesia was performed in 15 cases, spinal anaesthesia was performed in 15 cases with 25 G needles, and in 15 cases with 22 G needles. No statistically significant hearing loss was observed in the post-operative period compared to preoperative period in the epidural anaesthesia group. In the post-operative period, the hearing loss observed in the 25 G-spinal anaesthesia group was significantly (P<0.01) less than that seen in the 22 G group. None of the patients had headache after spinal anaesthesia. It was concluded that pure tone audiometry is a more sensitive indicator of cerebrospinal fluid leakage than post-operative headache.

One hundred and sixty-five cases of different kind of ossiculoplasty in patients suffering from chronic middle ear disease were performed at the ENT department of Papanikolaou Hospital in Thessaloniki, Greece, during the years 1988–1990. There were 40 cases of incus transposition, 47 cases in which polyethylene TORPs and PORPs were used and 77 cases of hydroxylapatite prostheses (41 TORPs and 37 double notch PORPs). Hearing success was defined as a post-operative air-bone gap of <20dB. According to this criterion 74 percent of the incus transposition cases were successful, 61 percent of the polyethylene TORPs, 65 percent of the hydroxylapatite TORPs, 40 percent of the polyethylene TORPs, and 89 percent of the double notch hydroxylpatite PORPs. It is obvious that ceramic PORPs produced the best results, while there was no statistical difference, regarding the hearing improvement, among the different kinds of TORPs which were used. Extrusion rate and other kinds of complications are also discussed, as well as a case of severely damaged ceramic TORP, within two years due to middle ear infection.

Contrary to previous practice, the eradication of posterior mesotympanic cholesteatoma can frequently be achieved using a transcanal approach and without the need for more major surgery. For success, certain specific steps are necessary. These are described and the results reported.

Because of the difficulties in studying the mechanical properties of the human tympanic membrane in situ, structural data from the cadaveric tympanic membrane samples is used for simulation of the surface structure of the tympanic membrane with the help of a computer. The hitherto poorly understood contour of the tympanic membrane is available for the development of a tympanic membrane and middle ear model.

This study investigated the effects of open-mastoid surgery upon ear canal resonance. In particular an attempt was made to alter resonant properties by obliterating each cavity with silastic foam. The results from this study showed that open-mastoid surgery significantly decreased resonant frequency without producing an effect upon either the peak amplitude or the quality of the resonant peak as defined by the Q-factor.

Restoring the natural resonance properties of an operated ear, if indicated, is likely to be a difficult objective to achieve in surgical terms.

A four-year study was undertaken to determine the value of electron microscopy in the diagnosis of head and neck tumours. During this period 80 samples were submitted for examination, of which 69 contained assessable tumour. Electron microscopy made a major contribution to the diagnosis in 25 cases (36 per cent). Areas in which ultrastructural examination was of diagnostic significance included the precise categorization of apparently undifferentiated carcinoma and the identification of melanomas. Little diagnostic benefit was gained from electron microscopic examination of thyroid, lymphoid or salivary gland neoplasms. The value of electron microscopy in relation to immunohistochemistry is discussed.

This prospective study assesses the role of intensive outpatient based conservative treatment in the management of aural polyp.

All cases of aural polyp that presented to the department during 1990 were included. Patients with obvious cholesteatoma or in whom inner ear or intracranial pathology was suspected were excluded as were children and patients who had undergone previous ear surgery.

We found that treatment with topical steroid/antibiotic decreases disease activity and renders subsequent surgery less extensive.

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.

A prospective study in 53 eligible patients, undergoing major head and neck cancer surgery was carried out to assess the combination of an ureido penicillin, piperacillin with a nitro imidazole agent, ornidazole, in order to prevent post-operative general and wound infections. Both antibiotics were administered for five days. Each patient had piperacillin 4 gm every eight hours and ornidazole 1 gm every 24 hours.

The overall rate of infections was 13.2 per cent (n = 7), with 3.8 per cent (n = 2) wound infections and 11.3 per cent (n = 6) general infections (one patient presented both complications).

There was no wound infection in the total surgery group (n = 12). General infections who only consisted of pneumonias were respectively 12.2 per cent (n - 5) in the group with partial procedures (n = 41) and 8.3 per cent (n = 1) in the total surgery group.

This antibioprophylaxis can be recommended in major oncological neck surgery, specially in the case of partial procedures.

The functional role of the paranasal sinuses in man has long been in dispute and as yet no satisfactory explanation has been offered for these ‘unwanted’ spaces. An answer may be found by study of the comparative evolutionary development of the sinuses in man and other higher primates.

Several unique physical characteristics of man not seen elsewhere in the ape family, or indeed in other terrestrial mammals, including some relating to the upper aerodigestive tract, are not satisfactorily explained by the traditionally held theory of evolutionary development of early man directly from the arboreal ape.

It is argued that these developmental differences are much more logically explained by a period of aquatic adaptation at a crucial period in the evolution of pre-hominid man. A new theory is proposed which might explain the importance of the sinus air cavities as buoyancy aids for protection of the upper airway tract in such an aquatic environment.

Further evidence is offered relating to a pathological condition of the external ear canal which supports this theory that man at some stage in his early development acquired an affinity for an aquatic environment.

Explanation of these unique hominid characteristics in terms of an aquatic evolutionary theory may help to resolve some of the enigmatic inconsistencies between man and other higher primates, and may account for man's eventual emergence as the dominant extant species, and perhaps an explanation for the ‘missing link’.

There have been few accounts of multi-channel cochlear implants in patients with congenital structural deformities of the inner ear which are associated with severe and sometimes progressive deafness. These malformations can now be recognized easily on 2 plane thin section high resolution CT studies which are mandatory for the pre-implantation assessment. However, no attempt seems to have been made to describe which of these malformations would be suitable for an implant or for which would this procedure be contra-indicated. True Mondini deformity of both the cochlea and dilated vestibular aqueduct type would appear suitable for a multi channel implant, but this type of implant should not be used for a primitive otocyst, severe labyrinthine dysplasia or the characteristic X-linked deformity.

Thalassaemia intermedia should be considered in any chronically anaemic patient presenting fromthe Middle East with hearing impairment. We report here three Saudi siblings with thalassaemia intermedia and features of severe bone marrow expansion, particularly invading the temporal bone. They were seen first for their otological problems before they had access to proper haematological evaluation. One member was admitted for surgical exploration of a cholesteatoma, which was then found to be marrow expansion of the temporal bone. Screening of the family revealed twomore anaemic siblings with thalassaemia intermedia. Audiological examination of all the family members showed that only the two affected members had a high frequency sen-sori-neural hearing loss.

Bone marrow expansion into the temporal bone is a rare feature of thalassaemia intermedia. Cholesteatoma-like lesion has not been previously described. It has to be considered in all cases of symptomatic thalassaemia intermedia manifesting with cavitation and lytic lesions in the mastoid system. The likelihood that sensorineu-ral hearing loss may complicate the thalassaemias israised and the possible mechanism for such involvement discussed. The proper management for different otological manifestations of the thalassaemias is suggested. These cases would suggest amore extensive involvement of the temporal bone in the thalassaemias than has been previously recognized. Further large scale studies are required to illuminate the subject.

Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinusradiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eyeappearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients.

It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.

Twenty two patients presented with otogenic tetanus. Seventeen patients had acute histories with only a single episode of otitis media with otorrhoea. Fifteen patients had unilateral central perforations, five had bilateral central perforations and two had no perforations but had acutely congested tympanic membranes which were bulging suggesting the presence of purulent fluid behind them. All patients with perforations had a purulent pulsatile discharge. A coexisting aerobic infection was seen in 85 per cent of the cultures and 59 per cent of these were due to staphylococcus aureus (versus 25 per cent in the controls). Only one patient had received partial immunization. Tetanus resulting from otitis media is not an indication for surgery.

The treatment of tympanic membrane retraction pockets by simple excision is described in 66 ears in 50 patients. After one operation 65 per cent of the retraction pockets were successfully treated (mean follow up 14.1 months). Persisting perforations occurred in five patients after one excision. Retrotympanic cholesteatoma was found in one patient, after two retraction pocket excision operations. The number of myringotomies with grommet insertion and the presence of bilateral disease does not predict the outcome of the procedure. Simple excision should be considered in the first instance, rather than reinforcement tympanoplasty using temporalis fascia or cartilage graft, in the treatment of tympanic membrane retraction pockets.

Controversy still exists concerning the ultimate fate of transposted or transplanted ossicles in tympanoplasty. Histological studies on autologous and homologous ossicles removed at revision operations, or from animal studies, vary in their conclusions. The viability, of such materials used in the long-term is still uncertain. Whether this has any functional significance is also uncertain.

This report contains a histological review of 10 ossicle remnants stored in the ‘closed’ mastoid cavity for 12 months, following closed cavity mastoidectomy (combined approach tympanoplasty)

In the quest for hearing preservation in patients with acoustic schwannomas it is essential that surgeons do not lose sight of the concept of ‘useful’ hearing. There is an important difference between hearing preservation which pleases the surgeon and that which will be appreciated by the patient.

Tumour size, pure tone audiogram average differences between ears and speech discrimination scores have been recorded in a series of 114 patients with unilateral acoustic schwannomas. Criteria for useful hearing are presented in terms of pure tone audiogram average difference and speech discrimination scores.

There were 11 patients (10 per cent) with a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 30 dB or better and a tumour size of no more than 2 cm. Only one patient (0.9 per cent) had a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 20 dB or better and a tumour size of no more than 1 cm.

It is concluded that hearing preservation techniques may be applicable to between 1 and 10 per cent of patients with unilateral acoustic schwannomas.

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.

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic.

There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes.

A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

Results of standard audiometry and tympanometry were compared with the Welch Allyn ‘Audioscope’ and ‘Microtymp’, in the diagnosis of secretory otitis media, in 100 children.

Standard pure tone audiometry had a specificity of 92 per cent and sensitivity of 51.6 per cent. The Welch Allyn ‘Audioscope’ a specificity of 84.2 per cent and sensitivity of 57.5 per cent; standard tympanometry a specificity of 71 per cent and sensitivity of 88 per cent; the Welch Allyn ‘Microtymp’ a specificity of 63 per cent and sensitivity of 90 per cent.

In view of cost, portability, and speed of testing the Welch Allyn instruments would be particularly suitable for community screening.

Pure tone audiometry with a pass threshold of 25 dB, at 2 and 4 kHz is a poor indicator of effusion.