Deviation of gait in a stepping test has been proposed as a useful indicator of peripheral labyrinthine dysfunction. A prospective study of 26 patients suspected of having uncompensated peripheral labyrinthine dysfunction and 49 normal patients with normal labyrinthine dysfunction showed no significant difference in performance of the Unterberger stepping test between patients with electronystagmographically significant canal paresis and those with normal vestibular function.

A radiographic planimetric study of mastoid air cell system was carried out on 100 normal human subjects of which 50 were males and 50 females–who were further subdivided into five age groups. They had no history of past ear disease or any other clinical ENT abnormality. The mean area of the mastoid air cell system was measured planimetrically on X-rays and the data analysed according to age and sex. It was 12.05±0.67 cm2 in males and 11.45±0.70 cm2 in females (which are more or less the same as that of Western people).

The size of the cranial bones has no apparent role in the size variation of the mastoid air cell system. The development of the latter was very rapid up to 10 years of age in both sexes and it continued even after 20 years of age but at a much slower rate.

The Ligmaject® syringe for local anaesthetic injection incorporates a pistol-grip handle and a ratchet system designed to inject a very tiny aliquot of anaesthetic per ‘click’. This instrument was used to provide local anaesthesia for 22 otological procedures on consenting adults. The performance of the Ligmaject syringe compared favourably with that of the conventional dental syringe in terms of patient acceptability and user convenience.

Treatment of otitis media with effusion is focused on reaeration of the middle ear cavity. In achieving longterm aeration, the insertion of ventilation tubes that have a long duration of stay can be beneficial. The results are presented of a trial in which the Goode T-tube was compared with the Armstrong tube. Fifteen children were treated between 1981 and 1986 with a T-tube in one ear and a conventional tube in the other. The results are different with regard to duration of stay in the tympanic membrane. Re-insertions were necessary in 47 per cent in the Armstrong group and in 20 per cent in the T-tube group. Otorrhoea occurred in 20 per cent of the Armstrong and 13 per cent of the T-tube intubated ears. A persistent perforation was present in 6 per cent of the ears in both groups. It is concluded that the Goode T-tube is indicated primarily in cases when long-term ventilation is needed.

We report six cases of partial lower motor neurone facial palsy occurring between four and ten days after uncomplicated stapedectomy. The aetiology is unclear but recovery was rapid and complete in all patients.

The results of revision endolymphatic sac surgery on 30 patients with unilateral Meniére's disease are presented. Good control is achieved in 73.3 per cent of cases at six months, falling to 56.7 per cent at one year and only 33.3 per cent by four years. The long-term results are disappointing but are more favourable if the initial surgery was successful, if the hearing remains fluctuant and improves on glycerol dehydration prior to the revision procedure and also if the sac is intubated. The current place of endolymphatic sac surgery is discussed and revision surgery only recommended for carefully selected cases.

In the ENT Department of the Royal Victoria Hospital, Belfast, the impression (supported only by anecdotes) was that electro-cautery was superior to chemical cautery in the treatment of simple anterior epistaxis. Since no evaluation of the relative merits of electro and chemical cautery has been reported, a prospective randomized study was conducted to assess the effectiveness of electro-cautery and cautery with silver nitrate. The results of the study showed that there was no statistically significant difference between the two methods in either controlling the epistaxis or in the incidence of complications. It is concluded that since cautery with a silver nitrate tipped applicator is simpler, and of equal effectiveness, it would appear to be the treatment of choice for simple anterior epistaxis.

Growth of the cricoid ring in infants is studied. In the first two weeks of life a small ring seems correlated with the fact of early infant death. Therefore we suggest that mortuary specimens at this age are not a reliable guide to the size of the cricoid in thriving infants.

Rates of growth from ages of two weeks to three years are given for the specimens examined. Comparison with similar measurements carried out in England show that the specimens collected here were systematically smaller for a given age.

In evaluating the long term results of surgical treatment of Reinke's oedema, there has been found to be a high incidence of recurrence. The recurrence rate is significantly lower amongst those patients who gave up smoking after treatment. A group of patients with chronic Reinke's oedema were followed for six months. Maximum efforts were made to help the patients to stop smoking. Twenty-nine patients entered the study, but only eight of them (28 per cent) refrained from smoking; all were women (39–70 years) and all experienced reduced discomfort, although none of the voices were restored to normal. Diffuse laryngitis disappeared completely, but the oedema did not disappear entirely in any patient. Before treatment of chronic Reinke's oedema patients must be well advised and informed, and if surgery is decided upon, they must be urged most strongly to stop smoking, if they wish to enhance the possibility of satisfactory long-term results.

The occurrence of multiple primary malignancies in patients with laryngeal cancer is well known. The possibility that lung cancer patients may be at risk of subsequent laryngeal cancer is less well recognized. The possibility of laryngeal cancer developing later has implications for the follow-up of lung cancer patients.

Three cases of subsequent laryngeal primary cancer occurring in survivors of bronchial cancer are presented and the implications are discussed.

Sixteen patients with end stage squamous cell carcinoma of the head and neck were admitted to a phase II study of alternating courses of cisplatinum (100mg/m2) and VAC (vincristine 1.4mg/m2, adriamycin 50 mg/m2, cyclophosphamide 750 mg/m2) given at three weekly intervals. Only two patients achieved a response (12 per cent). The median survival time was 62 days which is much the same as that of a similar group of patients who received no chemotherapy in a previous trial (70 days).

To evaluate whether age over 70 years represents a prognostic factor in head and neck cancer, we reviewed all cases observed between 1981 and 1984. Four hundred and thirty-eight (438) patients were considered in relation to three age groups (<59, 60–69, and >70 years, defined as non-elderly, mid-elderly and elderly respectively).

The main parameters analyzed included histological diagnosis (no difference emerged among the three age groups); anatomical site (hypopharyngeal carcinoma was most frequent in non-elderly patients); TNM stage (an higher incidence of early stages was seen in the elderly); performance status (better in the nonelderly); previous illnesses (life-style related diseases were more frequent in the non-elderly); contraindications to surgery (more frequent in the elderly); surgical treatment (‘en bloc’ resections were more often employed in the non-elderly); post-operative complications and local control (no difference between the three groups); multiple primary malignancies (head and neck, oesophagus and lung were more frequent in non-elderly patients) and survival (no difference).

Although age affects several features of head and neck cancer patients, it does not appear from the present study to be an independent prognostic factor for local control and survival. With regard to survival, stage appeared to be the most important prognostic factor.

We report a case of endolymphatic hydrops preceded by haemodialysis in the contralateral ear of a patient with known Menière's disease, and discuss the possible mechanism. It is suggested that the sudden decrease of plasma osmolality during haemodialysis acts as a reverse glycerol test. The audiometric and electrophysiological recordings pre- and post- dialysis and the induction of the Menière's triad of symptoms during dialysis, were strongly indicative of the presence of endolymphatic hydrops.

Antrochoanal polyps rarely present with severe epistaxis. We present the case of a young male patient who presented in such a manner, thus leading to the suspicion of an angiofibroma as the underlying pathology. The radiological investigations, treatment and pathological features are discussed.

Intracranial complications of frontal sinusitis, although rare today, do still develop despite widespread use of antibiotics. We report a case which demonstrates how silently a frontal lobe abscess may present with subtle changes in mood and behaviour, with no focal neurological signs. Diagnosis and management are discussed and a brief review of the incidence of intracranial complications of frontal sinusitis, mode of spread, clinical presentation, investigations, treatment and bacteriology is presented.

The peritumoural region of a squamous cell carcinoma of the tongue when examined with light and electron microscope showed nodular bodies in the submucosa with all the distinctive features of ‘sporangium’ and ‘spores’ of rhinosporidiosis. The occurrence of rhinosporidiosis in the tongue along with malignancy has not been reported hitherto. Some interesting observations and causal relationships are discussed.

Although upper airway obstruction and superimposed infection are well-known complications of infectious mononucleosis, lingual tonsillitis in this context has not been mentioned in the literature. We describe a case of acute bacterial lingual tonsillitis with airway obstruction complicating infectious mononucleosis. The role of the base of tongue region in the pathophysiology of infectious mononucleosis is discussed.

A 67-year-old man presented with a 45-year history of a weak voice. This was the result of polio which had left him with a right vocal cord palsy.

The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.

Malignant transformation of an adenolymphoma (Warthin's tumour) is a rare event. This paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland.