Malignant tumours of the ear canal and middle ear retain a poor prognosis despite the development of increasingly radical procedures. We report the combined experience of 61 patients presenting to our hospital over the past 30 years with this condition. Radiotherapy was the preferred initial treatment in almost all patients. Early surgical treatment by local resection just before or just after radiotherapy and radical mastoidectomy produced disease free survival for two to 20 years in 59 per cent (16 of 27) patients. Long term survival was achieved in 50 per cent of patients with carcinoma of the external auditory meatus and only 24 per cent of those with middle ear carcinoma. Salvage surgery produced a variable degree and duration of palliation but few survivors. Little was gained in the quality of life by petrosectomy.

A study was conducted to ascertain whether there is any relationship between parental smoking and various factors in children undergoing surgery for otitis media with effusion.

Information was recorded on 115 children admitted to hospital for grommet insertion. Details of parental smoking habits, previous surgery for ottis media with effusion and operative findings were noted. A group of 36 children with healthy ears attending an orthoptic clinic were used as controls.

Those children with at least one parental smoker were found to have a higher chance of being admitted to hospital for grommet insertion and were more likely to have had previous surgery for otitis media with effusion.

Besides the use of conventional techniques such as light and polarization microscopy, the present paper proposes the combined use of transmission electron microscopy, secondary and backscattered electron imaging, energy dispersive X-ray analysis and computed tomography for the diagnostic evaluation of ear pathology in the human fetus. These methods were used to revisit the primary calcification front of the fetal otic capsule between 16 and 23 weeks gestational age. Ultramicroscopic evaluation demonstrates similar fetal bone formation to that found in other bones of the human fetus. The formation of the endosteal and periosteal layers is a typical example of early intra-membranous ossification. The enchondral layer is made up of fibrillar bone, laid down around the calcified cartilage remnants. Microchemical analysis indicates a significantly higher Ca/P ratio in the endochondral layer with respect to the endosteum and periosteum. The consequences of a lower Ca/P ratio in the endosteal layer are discussed in view of calcium homeostasis and inner ear function.

Over a six month period, 709 children admitted for routine ENT operations were surveyed with regard to the presence of a bifid uvula as seen whilst under a general anaesthetic. The prevalence was found to be 7.5 per cent (53:709) which is higher than other published figures for a Caucasian population. There was a statistically significant male predominance (2.5:1). Comparision between those children found to have otitis media with effusion at operation and those having dry myringotomies, or operations not including myringotomy, revealed a similar prevalence of bifid uvula. Thus, this data does not support the hypothesis that bifid uvula as a microform of cleft palate is associated with an increased incidence of otitis media with effusion.

Traumatic middle ear lesions are quite common but only seldom mentioned in the literature; an isolated fracture of the handle of the malleus seems to be extremely rare. The appearance of two patients with an isolated fracture of the haddle of the malleus within one year might indicate that this type of lesion should be considered more frequently. The traumatic aetiology, symtoms, diagnosis and treatment of this lesion is described and is illustrated by two cases.

There are four principal modalities now used by the Radiologist to investigate the nose and paranasal sinuses. These are: plain X-ray, conventional tomography, computerised tomography (CT), and magnetic resonance (MR). Plain X-ray is the initial examination, and is used as a screening procedure before employing one of the tomographic techniques. Conventional pluridirectional tomography has now been superseded by CT scannning, which has the advantage of providing both good bone detail and soft tissue imaging. Since the introduction of magnetic resonance (MR), this technique has replaced CT as the optimum method of showing the extent of soft tissue tumour in the sinuses. The introduction of the paramagnetic contrast agent Gadolinium (Gd DTPA) has improved its accuracy. In the anterior fossa discrimination between cerebral oedema and tumour invasion is better shown, and in the sinuses tumour is more easily identified from retained secretion and inflamed mucosa. The best method currently available to show pathology in the nose and sinuses is a combination of GdMR and CT: the former to identify the soft tissues and the latter to show bone changes.

Recent studies have shown neuroendocrine-type cells in human spiral prominence epithelium. A light microscopic and ultrastructural study was made on the guinea pig spiral prominence epithelium to try and identify neuroendocrine cells. The study showed that such cells were not present in the guinea pig spiral prominence epithelium. The spiral prominence epithelium was characterized by uniformity of cellular staining with Toluidine blue and the ultrastructural appearance. The morphology of the spiral prominence epithelium was similar to that previously described. The absence of neuroendocrine cells in spiral prominence epithelium in the guinea pig is discussed in relation to species differences.

A secretory activity has recently been attributed to the endolymphatic sac (ES), as a possible way to contribute to the fluid balance of the entire endolymphatic compartment. Previous histochemical studies have indicated the existence of carbohydrate complexes in the secretory product, both neutral and acidic in nature.

A thorough analysis of these compounds in the gerbilline ES was carried out using both transmission electron microscopic (TEM) histochemistry, using dialyzed iron and periodic acid—chromic—silver staining techniques, as well as immunoflourescence with fluorescein-labelled lectins (FITC-lectins).

N-acetylglucosamine was found to be one of the major carbodhydrate components both of the epithelial layer of the ES and of the luminal precipitate. Proofs for a local secretory activity and its intracellular pathway are presented, suggesting to be involved in the regulation of pressure and volume of inner ear fluids.

The round window reflex is normally absent in stapedial fixation. In this study, six cases of oval window fistula are described in which the round window reflex was absent. This is probably because there is insufficient pressure transmitted to the round window membrane through the perilymph because of leakage from the oval window. This is considered as an important diagnostic sign of oval window/stapes footplate ligament disruption.

The patulous Eustachian tube syndrome has previously been regarded as a troublesome but benign condition. Nine out of 13 patients reported here had evidence of cochlear damage similar to that caused by acoustic trauma. These patients also had vestibular symptoms which improved with treatment of the patulous tube.

It is postulated that abnormal patency of the Eustachian tube may allow excessive middle ear pressure changes to occur which may be transmitted by abnormal ossicular movement to the cochlea.

Eustachian tube diathermy using a ureteric diathermy probe is a safe and effective method of treating this condition.

A postal questionnaire revealed the widest possible spectrum of opinion regarding tympanometry. The reasons are discussed.

Clinical tests of hearing are regularly used in adults but their role, now that pure-tone audiometry is almost universally available, has not been evaluated by modern methods of analysis including sensitivity and specificity.

Free-field voice testing was carried out in 101 patients and the Rinne tuning-fork test in a different group of 127 patients prior to clinical or audiometric evaluation. The results were subsequently compared to air and bone conduction pure-tone thresholds assessed using rigorous standards.

Depending on the audiometric definition as to what constitutes a hearing impairment, the sensitivity of free-field voice testing to identify such an impairment because of an inability to hear a whispered voice at two feet (60 cm.) was 86 per cent or better with the specificity being in the region of 90 per cent.

In the Rinne test the 256 Hz fork was superior to the 512 Hz fork (p<0.05) and the loudness comparison method superior to the threshold decay method (p<0.01) in detecting an air-bone gap. Combining the responses to the two forks did not improve the results. The Rinne test with the 256 Hz fork will identify correctly 48 per cent of individuals with a 15 dB, 69 per cent with a 20 dB, 87 per cent with a 25 dB, and 95 per cent with a 30 dB conductive impairment. In all instances the specificity is greater than 90 per cent.