The Nose/Ear Distress Syndrome is defined as ‘the combination of nasal septal deformity and eustachian dysfunction in the absence of any other pathology’ (McNicoll and Scanlan, 1979).

One hundred and two recruits to the Submarine, Diving and Aircrew branches of the Royal Navy, who at initial assessment had been found to have an intact, immobile tympanic membrane, when the Valsalva, Toynbee or Politzer manoeuvers were performed, were referred to the ORL Department, Royal Navy Hospital, Haslar, for further assessment as to their ability to serve in environments of primarily increased ambient pressure.

Forty-two qualified members of the Submarine and Diving Branches acted as controls, and they were known to have positive eustachian function, and also clinically mobile tympanic membranes on performance of the Valsalva manoeuvre.

Both groups underwent middle-ear analysis, using a Grason Stadler 1723 Middle-Ear Analyser, which has an additional facility for testing eustachian tube function.

Those subjects not in the control group were subjected to an increase in ambient pressure in the compression chamber at HMS Dolphin. The ability to equilibrate an increase in ambient pressure of 10 meters of water was regarded as the ultimate criterion of positive eustachian function, those who were unable to do this were diagnosed as suffering from the Nose/Ear Distress Syndrome.

Post-operative volume determinations have been made of the ear canals of 93 chronic ears operated on radically (removing the bony posterior meatal wall at operation, obliterating the surgical cavity by musculoperiosteal flap, and reconstucting the meatus, by soft-tissue only in 81 ears, or by cortical bone chips and soft tissue in 12 ears), and of 30 normal ears, using a liquied-filling method and by determining the compliance of the ear canal at a pressure of +200 mm. H2O.

The liquid-filling method gave more exact results than did the impedance measureemnts, and the results of the later showed more dispersion in all groups of ears. In 51 ears without post-operative cavities and reconstructed without bone chips, the mean value of the ear canal volume was 0.9 ml. by the liquid-filling method, and 1.5 ml, by the compliance method (p<0.001). The corresponding values for 30 ears with post-operative cavities, but without bony reconstruction of the meatus, were 1.5 ml. and 1.9 ml. (p<0.01). The values were 0.9 ml. and 1.2 ml. in 12 ears with posterior canal walls reconstructed with bone chips (p<0.01), and 0.8 ml. and 1.0 ml. in 39 normal ears (p<0.001). The liquid method seems to be a very exact method, but quite trouble-some in routine clinical use; the compliance method is suitable in most ears in which there has been bony reconstruction of the posterior meatal wall, but not in ears in which the posterior ear canal wasll has been reconstructed with solft tissues only, because the soft posterior meatal wall was mobile at +200 mm. H2O pressure.

Fascia and preserved homologous vein and pericardium have been used in consecutive order in 250 ear operations. Though successful closure of the defect, in cases with chronic ear infection, tended to be better with pericardium, auditory gain with pericardium seemed to be less than with fascia and vein. The differences, however, were not statistically significant. For the reason that it is easier to obtain, vein is the graft of choice in our institution when homologous graft is needed.

The frequency of post-operative cholesteatomas, epidermizations and retraction pockets in a series of 343 chronically infected ears (315 patients) without cholesteatoma at primary surgery was evaluated. The ears were operated on radically, exclusively by the Palva method, with removal of the bridge in 248 ears and preservation of it in 95 ears. Musculo-periosteal obliteration and seclusion of the aditus were performed in every case with a Palva flap and with a temporalis muscle-fascia graft. The primary operations took place over the period 1964–1972, and all the ears without cholesteatoma at primary surgery were included; they were followed up annually. The evaluation of this material was carried out in 1976–1979 and the follow-up time was on an average of 8.5 years (5–15 years).

Cholesteatoma was found in six (6/343; 1.7 per cent), epidermization of the tympanum in four (4/343; 1.2 per cent), and retraction pockets without cholesteatoma in six (6/343; 1.7 per cent) of the ears. Preservation or removal of the bridge at operation did not cause any significant difference in the frequency of the post-operative complications mentioned (p > 0 05). Most of the complications were discovered after the first postoperative year.