The history of the description of otosclerosis is presented in detail, beginning with Toynbee in 1857, together with the development of the surgical treatment beginning with Kessel in 1876. The prominent European and American contributors to this development are presented, with emphasis on the evolution of thinking with regard to surgical treatment as new information became available and new instruments were invented.

Surgery is the treatment of choice in the management of glomus tumours. There are several different approaches to the surgical excision of these tumours, the choice depending on the size, site of origin and pattern of spread of the tumour. The patterns of glomus tumour invasion in the temporal bone are demonstrated by reviewing the histological findings in four temporal bones with glomus tumours. The surgical techniques used in the management of 14 glomus tumours are also discussed.

This paper describes some unusual cures of ‘deafness and dumbness’ which have been used from ancient times down to the end of the seventeenth century. The cures described are presented in relation to the basic philosophical and religious beliefs regarding the causation of deafness as they existed first, during the Greco-Roman period; and secondly, during the Byzantine and Medieval periods. The influence of the rise and spread of Christianity on the medical treatment of deafness is also considered.

Since I introduced the homograft transplantation en bloc in 1959, more than 2,400 patients with chronic middle-ear inflammation and the conditions resulting from an old radical operation have been operated upon. Different kinds of chemical solution for the conservation of the homograft have been used, and experience has shown that the best solution is a combination of Cialit 1: 5,000 and formaldehyde 4 per cent, pH. 7-2. The indications for a homograft transplant have to be very precise, and we have divided the indications into two groups:

In the first group, belonging to routine ear surgery, we can use homograft fascia, perichondrium, dura, ossicles and cartilage in the same way as in autografts.

The second group is indicated when a larger part of the middle ear is destroyed. The healing process and function of the middle ear after homograft transplantation depend on correct indications, on preparation of the middle ear, on the correct fitting of the transplant, and on careful treatment after the transplantation.

By using homografts in routine surgery of the middle ear, the structural and functional results are equivalent to those of autografts.

In the second group, in which a large part of the middle ear is destroyed, or in which the condition resulting from a radical operation is achieved by an immediate fresh operation on the middle ear, the healing and functional results are much better than with patients after an old radical operation.

Results of 1065 operations (604 myringoplasties‡ and 461 tympanoplasties §) performed by a single surgeon using either underlay homograft dura, underlay autograft temporalis fascia or overlay autograft temporalis fascia are compared.

Pre-operative and operative conditions are analysed to determine which of these influence results.