Our ongoing evaluation of the results of laser assisted uvulopalatoplasty (LAUP) for snoring is presented. Follow-up between 18 and 24 months post-treatment completion, of patients with a successful result at six months, reveals that 22 per cent of these patients suffer failure of snoring control between these two evaluation points. This equates to an overall success rate at this time of 55 percent.

LAUP, like other surgical remedies for snoring, has a continued relapse rate. This must be considered when counselling patients.

This paper focuses upon the quality of the Dutch translation of the STSS (Subjective Tinnitus Severity Scale), a scale which assesses the severity of tinnitus and the related distress. Research has been done on the psychometric qualities of this scale, its relationship with loudness-matching procedures and several psychological variables. Data presented on 104 tinnitus patients demonstrated the reliability of the STSS with a coefficient alpha of 0.71. Factor analysis revealed four factors: emotional distress, intrusiveness, annoyance and cognitive distress. With regard to the validity, significant correlations of a moderate degree were found with several unitary subjective scales measuring the same construct (rs = 0.50, p<0.001 and rs = 0.43, p<0.01). Correlational research demonstrated that the STSS is independent of the loudness of tinnitus as measured by matching procedures (rs = 0.00).

In contrast, significant correlations of a moderate magnitude were found with anxiety (rs = 0.33, p<0.001) and depression (rs = 0.31, p<0.01 and rs = 0.35, p<0.001).

Considerable controversy surrounds the subject of tympanoplasty in children. This prospective study looked at the results of type-I tympanoplasty in children. Forty-five children in the age group of five to 14 years were selected for the study. All these cases had a central perforation without any evidence of cholesteatoma. The ear to be operated had to be dry for at least six weeks before surgery. Type I tympanoplasty was performed on these patients with autograft temporalis fascia by either the underlay or overlay technique.

The overall success rates in 45 operations evaluated one year post-operatively was 91.1 per cent. The age of the patient had no influence on the success rate. The two factors which adversely influenced the success rate were the presence of near total perforation and bilateral perforations.

It was concluded that type-I tympanoplasty has a good chance of success in children regardless of age.

Fifteen routine nasal polypectomy specimens submitted to our laboratory over an eight-month period were noted to show marked atypia within areas of squamous metaplasia to a degree suggestive of dysplasia. Reviewing the literature revealed little published work in this area, especially recently. Further nasal polyp cases from this, and a similar previous time period, were re-examined, and possible causes for these changes discussed.

Surgery is the first therapeutic option in extensive oropharyngeal carcinomas. An operation to treat these tumours is described, based on the hemiglossopelvectomy without mandibulectomy technique. Tumours located in the oropharynx are resected downwards by a modified pull-through approach, performing the resection of the oropharyngeal tumour in monoblock with the ipsilateral neck dissection, avoiding any action upon the mandible. The operation has been performed in 14 consecutive patients. By avoiding either mandibulotomy or mandibulectomy, morbidity and post-operative recovery are improved.

The diagnosis of conductive hearing loss is usually based on audiological methods and radiology. The aim of our study was to show that there is a useful additive method to clarify the findings of diseases with conductive hearing loss.

Patients (151 ears) with conductive hearing loss were examined using several methods: otomicroscopy, air- and bone-conduction threshold, pure tone average, speech threshold, speech discrimination, tympanometry and stapedial reflex and tympanoscopy.

The management of the patients changed in 17 per cent of cases due to tympanoscopy. In a group with normal tympanic membrane the movement of the stapes during endoscopy was compared to stapedial reflex. Stiff stapes were found more often than an abnormal stapedial reflex.

Middle ear endoscopy can increase the accuracy of diagnosis of conductive hearing loss thus enhancing decision making in the case of the patient.

Histological features and prognosis of patients with mucoepidermoid carcinoma of the parotid gland were analysed. Tumours from 13 patients were classified according to histological grades and immunoreactivity for HEK-2/neu. Surgical resection of the tumour was performed for all patients, and the overall five-year survival rate was 69 per cent. The patients whose histological grades were 1 or 2 showed a 100 per cent five-year survival rate, but no patient with grade 3 survived five years. Also, patients who had tumours that overexpressed HER-2/new had a lower survival rate (25 per cent) than patients with tumours that had weaker immunostaining (89 per cent). We considered tumours classified as grade 3 plus strong HER-2/neu expression to be ‘high malignancy’, and compared them with ‘low malignancy’ tumours that were grade 1 or 2 and had weaker HER-2/new staining. Patients with high malignancy tumours had shorter recurrence-free intervals and shorter overall survival than patients with low malignancy tumours. The overall survival period of the low malignancy cases was much longer than the recurrence-free interval; unlike that in the high malignancy tumour patients. These results suggest that the combination of histological grades and expression of HER-2/neu may be a useful predictor of the prognosis for mucoepidermoid carcinomata.

Forty-five patients with residual or recurrent nasal polyposis after ethmoidectomy were treated with either cetirizine at twice the daily recommended (20 mg) dose or placebo for three months. The number and size of polyps remained unchanged during the study period. Cetirizine was found to reduce nasal sneezing and rhinorrhoea effectively. The drug also had a beneficial effect on nasal obstruction in the latter part of the study. The side effects of 20 mg (double the recommended daily adult dose) of cetirizine were few and comparable to placebo.

Hypopharyngeal carcinoma (HPC) has a poor prognosis. We investigated the expression of cyclin D1 in 34 advanced HPCs, and the value of cyclin D1 expression was evaluated as a predictive marker in terms of the prognosis of HPC, compared with other clinical factors. Using immunohistochemical staining, 20 of 34 patients showed positive immunoreactivity for cyclin D1. The statistical trend of the survival rate was lower in the cyclin Di-positive patients than in the cyclin D-negative ones (p = 0.0805). The predictive factors for the survival rate were effectiveness of neo-adjuvant chemotherapy (F = 8.698) (p = 0.0066), cyclin D1 expression (F = 6.244) (p = 0.0191) and N classification (F = 5.037) (p = 0.0335). The cyclin D1-positive patients had approximately four-fold higher mortality than the cyclin D1-negative ones. These data indicate that the expression of cyclin D1 in advanced patients with hypopharyngeal carcinoma is a useful marker for prognosis.

Adenoidectomy and tonsillectomy are amongst the most common surgical procedures carried out in children. We undertook a prospective audit in the Highlands of Scotland to document the views of general practitioners, parents, nursing staff and anaesthetists on admission and discharge policy. Of responses from 149 general practitioners, 119 (80 per cent) were in favour of change to same day admission and 22 (15 per cent) were not in favour. For change to same day discharge for adenoidectomy, 55 (37 per cent) were in favour and 81(54 per cent) were not in favour. For change to next day discharge for tonsillectomy, the figures were 51(34 per cent) and 89 (60 per cent) respectively. Responses from 14 trained paediatric nurses comprised 13 not in favour of same day admission, six in favour and seven not in favour of same day discharge for adenoidectomy and all 14 not in favour of same day discharge for tonsillectomy. All eight Consultant anesthaetists approached were happy with a change in policy to same day admission for children who were otherwise fit and well. Thirty-seven parents (70 per cent) preferred previous day admission and 14 (29 per cent) were happy with same day admission for their children. On the basis of these results, day-case adenoidectomy or tonsillectomy is not being considered in this area. Moves have been made, however, toward a policy of same day admission and next day discharge.

Patients with far-advanced otosclerosis (FAO) may appear to be suffering from profound sensorineural hearing loss and are frequently directed to cochlear implantation programmes. In order to avoid such misdiagnosis, FAO should be considered in patients with non-measurable bone-conduction levels and airconduction levels exceeding 85 dB. Specific clues can lead the clinician to suspect otosclerosis as the aetiology of hearing loss. A review of eight patients (nine ears) with FAO who underwent stapedectomy from 1985–1995 reveals that six of the eight (75 per cent) who had been unable to use a hearing aid preoperatively obtained serviceable hearing with a hearing aid after surgery. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients; some are better off with stapedectomy.

The Chief Medical Officers' expert advisory group (The Calman Hine report) (1994) for the commissioning of cancer services suggested that services in the district general hospitals (DGH) should be called ‘cancer units’ and that such units should be closely linked to ‘cancer centres’. The objective of these proposals would be to improve the quality of care to cancer patients. The report also acknowledges that these proposals are based on an inadequate understanding of the epidemiology of cancer within England and Wales and the way in which current configuration of services affects outcome. The authors make a plea for better documentation and recording of treatment and outcomes (i.e. audit) to fill this gap. Registration in cancer registries is of limited value in assessment of outcomes of care owing to lack of detail. This paper describes an audit of head and neck cancer in one department and attempts to define which patients might benefit from referral from the cancer units to the ‘centres’, and conversely, which patients would be better managed in the cancer units. If all patients with cancer of the head and neck were referred, the service in the cancer centres would be overwhelmed. Some system of triage will therefore be essential.

Advances in telecommunications technology in the last decade have fostered the development of computer networks that allow access to vast amounts of information and services. The most prominent is the Internet (Glowniak, 1995). Medical information is increasingly available on such computer networks. The purpose of the present article is to provide an update to previously published otolaryngology sites (Johns, 1996; Burton and Johns, 1996) available on the World Wide Web, and to provide the otolaryngologist with details of resources that are accessible via the Internet. However, the reader should also be aware that the uniform resource locator (URL) addresses of Web sites can change without warning.

Records are available on 27 patients who had vestibular nerve section between 1975 and 1987 giving a follow-up time of 10 to 22 years with a mean of 16 years. Episodic vertigo was fully controlled in 26 patients, one needing a labyrinthectomy 18 months later.

In addition to the patient who had labyrinthectomy, one patient had immediate post-operative profound hearing loss so that long-term follow-up of hearing was possible in 25 patients. After six months there was an overall average improvement in hearing of 1 dB. Thereafter there were average deterioration of 7 dB at two years, 15 dB at 10 years, 23 dB at 15 years and 29 dB at 20 years. This deterioration was more marked in those who had better hearing at the time of surgery, with all 10 whose hearing was classified as good deteriorating to poor by 15 years. At 10 years hearing deteriorated by 25 dB in those with good hearing and by 7 dB in those with poor hearing. In 20 per cent of patients there was audiological evidence of eventual involvement of the other ear.

Tinnitus became worse in five patients but was a major problem in only one patient. One patient suffered a facial paralysis with partial recovery and, in addition, in one the frontal branch was divided in the incision.

The microbiology of 87 patients admitted to hospital, over a five-year period, with acute sinusitis was retrospectively analysed. Sixty-three patients had one or more of an orbital, intracranial, soft tissue or bony complication. Eighty-four patients had maxillary sinus washouts, while 48 required a surgical procedure to their sinuses, and 33, drainage of an empyema. Streptococcus milleri and Haemophilus influenzae were the commonest organisms isolated from sinus aspirates (44 per cent), with a noticeable absence of Streptococcus pneumoniae (10 per cent). Organisms cultured from intracranial, soft tissue or orbitral empyemas were predominantly Streptococcus milleri (50 per cent) and Staphylococcus aureus (25 per cent) with an absence of Haemophilus influenzae (four per cent) and Streptococcus pneumoniae (four per cent). Ampicillin is an appropriate first line antimicrobial agent in patients with acute complicated sinusitis with the addition of cloxacillin in cases with an empyema. Chloramphenicol or ceftriaxone is used in cases with an intracranial complication.

The usefulness of computed tomography (CT) in the diagnosis of fish bone impaction in the oesophagus was evaluated. Thirty-two patients were examined by plain X-ray followed by direct oesophagoscopy for suspected fish bone impaction. Among 25 cases in which fish bones were actually removed, foreign bodies were not clearly demonstrated by plain X-ray in 14 cases (56 per cent). Eleven cases underwent CT prior to the oesophagoscopic examination. Fish bones were clearly demonstrated by CT in all patients. CT also clearly visualized secondarily-induced inflammatory changes in the neighbouring structures. In order to confirm this result, we made a simulation model of oesophageal fish bone impaction, using fish bones of three different species surrounded by a water bag. In comparison with plain X-ray, CT depicted a superior image of fine fish bones and provides extremely useful information for the management of impacted fish bones in the oesophagus.

Aural ventilation tube insertion is the most common otological operation and is usually the first operation learnt by trainees. The limited supply of temporal bones as well as expensive commercial models hampers training in the procedure. This paper describes a simple solution making a model of the ear canal and drum out of materials available on an ENT ward.

The results of a retrospective study of 22 patients with inverted papillomas resected by the endoscopic approach are presented with a follow-up of 33 to 96 months. Twenty-one patients had unilateral disease and one patient had bilateral involvement. None of the patients had orbital or cranial extension. One patient had synchronous carcinoma in situ. Eight patients had undergone previous surgical procedures. Following endoscopic surgery, six patients had residual disease requiring further revisions. Three of these six patients eventually required excision via limited external approaches. No patient required lateral rhinotomy or mid-facial degloving procedures. No complication occurredin any of the patients. The advantages of endoscopic surgery include precise determination of tumour extent, preservation of normal mucosa and bony structures and avoidance of external scars. Close endoscopic follow-up is mandatory to ensure early recognition and treatment of recurrent disease. Although the endoscopic approach is gaining popularity for the treatment of inverted papilloma, indiscriminate application may result in a high recurrence rate. The endoscopic approach should be performed by experienced surgeons and restricted to carefully selected patients with nasal, ethmoidal and limited maxillary disease. More extensive disease should be managed by radical external approaches or by combining endoscopic with limited external approaches.