We describe the assessment procedures used at Charing-Cross Hospital to investigate laryngectomees who failed to develop oesophageal voice and give the results of assessment in 50 patients. Anatomical or physiological abnormalities in the reconstructed pharynx were found in all patients, and we feel these significantly contributed to the failure of achieving an oesophageal voice. The four cases of failure were due to hypotonicity of the pharyngo-oesophageal muscles, hypertonicity, frank spasm and stricture. This distinction can be used as a functional classification of failure as treatment for each group has to be different if successful surgical voice restoration is to be achieved. Patients with hypotonicity need to use external pressure; those with mild hypertonicity are able to use a low pressure tracheo-oesophageal voice prosthesis; those with spasm need a pharyngo-oesophageal myotomy prior to “puncture”, while those with stricture need surgical correction.

During the 10-year period 1972–1981, 3,688 and 867 oesophagoscopies were performed at two ENT clinics of a university hospital and of a country hospital with an incidence of oesophageal perforation of 0.8 per cent and 1.1 per cent respectively.

Rigid instruments were used in all cases, most often in combination with dilatation of a benign stricture.

Twenty-one total pharyngo-laryngectomies have been performed at the Manchester Royal Infirmary between 1968 and 1982. A variety of methods of repair have been used, gastric transposition being the most common. Seventeen patients had received previous radiotherapy to the area, fourteen radical, two palliative and one to a supraglottic carcinoma 12 years before. Four had tumours judged to be too large to benefit from radiotherapy.

Of the patients who received radiotherapy, fourteen had a good response with palliation for an average of ten months before symptoms began to return.

Four patients survived over five years post-operatively and ten died following surgery.

Twenty-three cases of malignant tongue tumours in patients aged 15 to 30 are reported. Treatment and prognosis in the 18 for which follow-up information is available are discussed. The disease appears to be very similar to that in older subjects except for a greater incidence of neck node metastases. Close follow-up after primary treatment is essential since there is a high possibility of recurrent disease but which may respond well to salvage surgery if identified early. A greater awareness of the occurrence of tongue cancer in young adults is also necessary.

An exteremely rare case of traumatic thermal injury of the middle and inner ear with deafness and irreversible peripheral facial palsy is presented. The accident was caused by a metal spark perforating the tympanic membrane during welding.

Two cases of median nasal dermoid fistulae are presented. This is an uncommon developmental abnormality which may present either to ENT Surgerys, Plastic Surgeons, or Dermatologists. Although the extent of the tract in our cases was small, careful pre-operative assessment is required as the tract may be ectensive.

Forty four free vascularised tissue flaps have been used in the reconstruction of defects arising following the treatment of malignant disease of the head and neck in 42 patients over the period January 1983 to September 1984. The uses of free flaps and their advantages and disadvantages when compared with other methods of reconstruction are described.

Various forms of dressings, including proflavine wool, have been used traditionally for pinnaplasties.

We report the use of Silastic Foam as a dressing in seven of our pinnaplasty cases. The advantages of Silastic Foam dressing over conventional dressings are mainly:

1. Patient comfort.

2. No change of dressing is required.

A 51-year-old man developed prolonged papilloedema as a result of increased cerebrospinal fluid pressure following staged bilateral radical neck dissection. The patient recovered completely with no further specific therapy. Although the prognosis for vision is usually good in patients with longstanding papilloedema due to raised cerebrospinal fluid pressure, permanent visual impairment remains a serious complication. In the presence of anatomical variations of the venous pathways by which the blood leaves the brain, a raised intracranial pressure may also develop following unilateral radical neck dissection. Nine cases of increased intracranial pressure following unilateral radical neck dissection reported in the literature until now are briefly reviewed.

A 56-year-old woman presented with unilateral tinnitus and hearing loss for 18 months. A middle ear mass was detected clinically. At operation, the tumour was found to have eroded the stapes. The light and electron microscopic features of the tumour were those of a middle ear adenoma. This rare benign tumour has an excellent prognosis. Erosion of an ossicle has not been previously associated with this tumour.

Benign adenomatous tumours arising from middle ear mucosa are rare (Mills and Fechner, 1984). The term adenoma of middle ear was proposed by Hyams and Michales (1976), and their review of 20 cases emphasized the benign behaviour of these tumours. We report a case of middle ear adenoma in which ossicular erosion occurred.