A prospective study comparing surgical and antibiotic treatment for recurrent tonsillitis in adults suggests that, whilst tonsillectomy is very effective, adequate medical treatment provides an equally good alternative in the majority of patients.

The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech.

Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion.

Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood.

Sixty-five primary malignant laryngeal tumours, other than simple squamous cell carcinomas, treated at the Royal Marsden Hospital between 1949 and 1984 are presented. Of the 11 histological types pseudosarcomas (24 cases), verrucous carcinomas (9 cases) and lymphoreticular tumours (9 cases) predominated. Determinate three-year follow-up data were available in 50 cases. Sixteen patients (32 per cent) died of their neoplasms but survival was strongly related to histology. Only one death occurred among 24 determinate cases of pseudosarcoma and verrucous carcinoma. Radiotherapy was effective treatment for these two tumour types and for reticuloendothelial tumours. However, combined therapy yielded poor results with the other histological types.

The present study aims at an assessment of hepato-splenomegaly in infectious mononucleosis (IM). In 29 patients admitted to the ENT department with IM, based on the typical clinical and laboratory findings, including a positive mononucleosis test in most cases, the size of the liver and spleen was estimated by ultrasonic scanning on days 1, 3, 5, 10, 20, 30, 90 and 120 after admission. A control group of eight patients with peritonsillar abscess was included for comparison. The results showed that all patients had an enlarged spleen (mean enlargement: 50–60 per cent) but only a few were palpable. Half of the patients had enlargement of the liver (5–20 per cent), which was palpable in only 8 per cent. There was no correlation between the size of the spleen and that of the liver, not between the changes in the size of these organs. There was no enlargement of the liver or spleen in the control group. No correlation was found between the size, or changes in the size, of the organs and blood values such as lactatdehydrogenase and aspartatamino-transferase. There is, however, a striking parallelism between the curves for these parameters, which might indicate that the organs as well as the blood tests return to normal within 28 days. If this holds true, our warning to abstain from physical exercise and alcoholic intake may be limited to a period of about 1 month.

A rare case of marble bone disease in a child is presented. The salient features of the disease are discussed in the light of available literaute.

A 69-year-old white female had a left superficial parotidectomy for a papillary cystic oncocytoma. The histologic appearance was identical to Warthin's tumor except that it lacked a lymphoid component. This case suggests that the general morphology of a Warthin's tumor does not depend on the presence of lymphoid tissue or association with an intra-parotid lymph node. We reviewed 50 patients with Warthin's tumor to investigate the histogenesis of the lesion. We found that most Warthin's tumors (86%) appeared to be within lymph nodes, as indicated by the presence of a lymph node capsule or sinuses. The anatomy of intra-parotid lymph nodes in glands containing Warthin's tumors has been compared with that found in 11 parotid glands containing mucoepidermoid carcinomas. So-called heterotopic ductal inclusions may actually represent the normal intimate relationship of parotid gland to intra-parotid lymph nodes.