A group of 67 children were studied (mean age 7 years, 2 months) who underwent adenoidectomy and/or tonsillectomy because of either recurrent otitis media or upper respiratory tract infection. The mean pre-operative intratympanic pressure was –67.3 mmH20 (SD 65.1); three months post-operatively it was –21.9 mmH20 (SD 32.4), a highly significant improvement (p<0.001). The size of the adenoids had a nearly significant effect on the pre-operative intratympanic pressure (p<0.05). In children with large vs small adenoids the difference was highly significant (p<0.001). In a group of five children, tonsillectomy along (adenoidectomy performed earlier) did not have any effect on the intratympanic pressure. No change in intratympanic pressure was seen in children with nasal allergy as compared with non-allergic children after adenoidectomy.

Many studies have been reported on the intratympanic ototoxicity of different drugs in animal models. The recovery periods of the animals following intratympanic drug applications varied among these studies. The present study compares the cochlear damage caused by intratympanic kanamycin following short (4 days) and long (30 days) post-injection survival periods, using the guinea pig as the animal model.

The degree of cochlear damage 4 days after kanamycin injection was consistent among the tested animals. The degeneration was mainly confined to the outer hair cells and almost all inner hair were spared. The change 30 days after kanamycin injection was more variable among the animals and both inner and outer hair cells were damaged. This shows that, although the damage to the cochlea after intratympanic aminoglycoside injection is progressive, a short post-injection recovery period is suitable for comparative intratympanic ototoxicity studies.

The diagnostic criteria of malignant external otitis (MEO) have been reviewed. They were divided into two categories: obligatory and occasional. The obligatory criteria are: pain, edema, exudate, granulations, microabscess (when operated), positive bone scan or failure of local treatment often more than 1 week, and possibly pseudomonas in culture. The occasional criteria are diabetes, cranial nerve involvement, positive radiograph, debilitating condition and old age. All of the obligatory criteria must be present in order to establish the diagnosis. The presence of occasional criteria alone does not establish it. The importance of Tc99 scan in detecting osteomyelitis is stressed. When bone scan is not available, a trial of 1–3 weeks of local treatment is suggested. Failure to respond to such treatment may assist in making the diagnosis of MEO.

Ninety-one habitual nose-bleeders were screened for haemostatic disorders. 46 screening results in 38 nose-bleeders were outside the normal range. After extended investigation, it was found that 25 (27 per cent) habitual nose-bleeders had haemostatic disorders, all except one in the primary haemostasis. The disorders found could be classified as mild bleeding disorders (MBD) and compared to the estimated frequency of MBD in the population there was an increased incidence of haemostatic disorders in the habitual nose-bleeders. Abnormal vessels in the nasal mucosa were present in 85 per cent of the investigated nose-bleeders, equaly distributed between nose-bleeders with and without haemostatic disorders. This indicates that abnormal vessels and haemostatic disorders occur independently of each other. When screening for haemostatic disorders in habitual nose-bleeders, it is possible to detect previously unknown but clinically important disorders.

To assess the prevalence of otitis media in Tanzania a study was made of 3772 patients attending for the first time the ENT out-patient department of Muhimbili Medical Centre, University Hospital of Dar es Salaam. Otitis media in one form or another was present in 524 patients (14 per cent). The majority reported a long history of ear discharge.

Hearing loss was a major complaint and was often found to be between 40–60 dB. H.L. Most patients admitted previous treatment, but otoscopy had rarely been performed. The medical profession in Tanzania cannot possibly deal with the large number of cases of chronic otitis media.

With the recent introduction of otorhinolaryngology into the curriculum of the medical school of Tanzania it seems advisable to include otology in the programme for primary health workers.

Soft-tissue reaction to ceramic ossicular replacement prostheses (CORP) has been evaluated histologically in rabbits and humans. One week after implantation, severe inflammatory and foreign body reaction was observed in the fibrous connective tissue surrounding the prosthesis. Though some inflammatory response was seen after one month, after three months the CORP was surrounded by a layer of fibrous connective tissue without any foreigh body giant cell, histiocyte or inflammatory cell infiltration. Our satisfactory clinical results in humans without placing a cartilage between the CORP and the fascia graft may be due to the excellent softtissue compatibility of CORP, as demonstrated in this study.

Vestibular Habituation Training (VHT) is the treatment of choice for paroxysmal positional vertigo (ppv). The origin of the disturbance is peripheral and the data observed in the cases treated confirm that it is not located in horizontal canal function. However, canal dysfunction can be present together with ppv. Usually a separate course is observed for the phenomena attributed to horizontal dysfunction and those to the ppv lesion.

The specificity of the Dix-Hallpike manoeuvres linked to the typical ppv is also confirmed by the data obtained by testing for VHT (VHT-test-battery).

Ppv can have a repercussion upon the vestibulospinal reflex. That the same ppv disturbance can coincide with normal as well as with abnormal posturographic data, pleads for the intervention of central adaptive mechanisms. The effect of VHT is due to stimulation of these central adaptive mechanisms and not to any impact upon the peripheral lesion.

The modern surgical treatment of otosclerosis consists of replacement of the sound conducting function of the stapes by a prosthesis. The results obtained in 100 consecutive patients using the small fenestra technique and a 0.4 mm. Teflon and steel wire prosthesis are reported. The surgical technique is described. The hearing was improved in all patients. In 92 per cent of the patients an optimal hearing gain was found after an observation time of 1 to 4 years. Five patients required re-operation during the observation time. The small fenestra technique and the Fisch prosthesis were considered optimal in respect to technical difficulty, hearing improvement and complication rate. There was no sensorineural hearing loss in this series of patients. The absence of serious complications makes it reasonable to operate on both ears in patients with bilateral hearing loss. The results are as good in elderly people as in younger people. Therefore the operation can be offered for patients in all age groups.

The object of this double-blind study was to assess the therapeutic effects of a combination of two per cent sodium cromoglycate and 0.025 per cent xylometazoline compared with a matched placebo. Forty patients were included in the two-week study.

The treatment was found to be rapidly effective taking only a day to control symptoms in almost 80 per cent of the patients in the group receiving active treatment.

No evidence of rebound effects due to the decongestant was observed during the study.

The operation of submucosal diathermy is commonly performed for the relief of nasal obstruction due to mucosal swelling. In this study the effect of the procedure on nasal resistance to airflow is assessed by rhinomanometry. The results show that although the operation is effective in the short term (two months), there is no significant difference between the nasal resistances prior to surgery and at 15 months after surgery.

The intranasal distribution of aerosol from a metered dose inhaler has been assessed using a radiotracer technique. Inhalers were prepared by adding 99Tcm-labelled Teflon particles (simulating the drug particles) to chlorofluorocarbon propellants, and scans of the head (and chest) taken with a gamma camera. Ten healthy subjects (age range 19–29 years) each performed two radioaerosol studies with the inhaler held in two different ways: either in a single position (vial pointing upwards) or in two positions (vial pointing upwards and then tilted by 30° in the sagittal plane).

The vast majority of the dose (82.5 ± 2.8 (mean ± SEM) per cent and 80.7 ± 3.1 per cent respectively for one-position and two-position studies) was deposited on a single localized area in the anterior one-third of the nose, the initial distribution pattern being identical for each study. No significant radioaerosol was detected in the lungs. Only 18.0 ± 4.7 per cent and 15.4 ± 4.1 per cent of the dose had been removed by mucociliary action after 30 minutes, and it is probable that the remainder had not penetrated initially beyond the vestibule. Since the deposition pattern was highly localized and more than half the dose probably failed to reach the turbinates it is possible that the overall effect of nasal MDIs is suboptimal for the treatment of generalized nasal disorders.