Assessment of the maxillary antral mucosa in chronic sinusitis prior to surgery is notoriously difficult. Sinoscopy using a Hopkin's rod system is proving increasingly popular. The accuracy diagnosis of mucosal disease by this means in 26 antra is here correlated with histological evidence of inflammation and bacteriological evidence of infection in antral mucosal biopsies. It is shown that the surgeon's assessment of the mucosal appearance correlates well with the histology and bacterial culture. Absence of mucopus or bacterial growth on culture did not indicate absence of disease.

Fifteen subject underwent nasal pressure gradient studies to determine the resistance profile of the nose. Seventy-nine per cent of nasal resistance to airflow occurred in the segment 0 cm.−2.8 cm. from the posterior margin of the anterior nares. The greater part of this resistance (43 per cent) occurred in the segment 1.5 cm.−2.8 cm. within the nose, and this area approximated to the site of the pyriform aperture.

Eighteen patients underwent a trial of radical trimming of the turbinates (12 patients) versus anterior trimming of the inferior turbinates (6 patients). Both operations produced a similar fall in nasal resistance to airflow, confirming that the region of the pyriform aperture was the site of maximum nasal resistance.

Whereas the radical operation significantly reduced the sensation of nasal obstruction, the anterior operation did not.

The results of the study are discussed with reference to previous work on the subject.

We present a study of 22 patients with perennial non-atopic rhinitis who have been treated with a course of topical beclomethasone diproprionate (Beconase). All subjects were skin-test negative for the common inhaled allergens and had normal total and specific IgE levels. The results of treatment were assessed by symptom scoring and by active anterior rhinomanometry, and are compared to measurements of resistance made in 22 untreated controls and an equal number of normal volunteers.

Mast cells in rats have been categorized into mucosal and connective tissue mast cells by properties which include their fixation characteristics and their distribution in tissues. There are a number of factors which make his classification unsatisfactory including the variability of fixation, intensity of background staining and the application of animal studies to man. Seasonal allergic reactions in the nose of man occur both in the surface metachromatic cells and in those within the epithelium; the latter are presumed to be mucosal mast cells. The aim of this study was to look at the distribution and the fixation characteristics of mast cells in inferior tubinates and nasal polyps. Both techniques show that cells are more abundant in the submucosa and the fact that Carnoy's fixative shows them better and this may be due to the lack of intensity in the background staining. There is no evidence that mast cells are more frequent in the epithelium. These findings would suggest the nasal polyps are not an allergic disease.

To date only few and often disagreeing studies about human nasopharynx are available.

The present research has the purpose to give a contribution to the knowledge of nasopharyngeal epithelium using S.E.M The study was carried out on biopsies taken from 20 healthy volunteers.

The surface of nasopharynx is covered by ciliated cells, microvilli provided cells and goblet cells.

Areas covered with squamous epithelium and presumably transitional epithelium were observed.

The possibility that ciliated become microvilli provided cells is discussed.

The presence of upper respiratory tract obstruction in patients with acromegaly has been described. The main sites for obstruction were previously thought to be laryngeal and oropharyngeal. This reviews 65 patients with acromegaly and 27 patients with a prolactinoma treated by trans-ethmoidal hypophysectomy. The results confirmed a very high incidence of polyp formation and mucosal hypertrophy within both the sphenoid (88 per cent) and ethmoidal (62 per cent) sinuses of the acromegalic patients. The histological appearances of the mucosal hypertrophy and polyposis confirmed no specific features attributable to acromegaly. Patient age and serum H.G.H. level do not appear to be significance factors. These findings within the para-nasal sinuses have never previously been reported.

Olfactory and auditory function was examined in five patient with type I pseudohyppoarathyroidism; in two patient the activity of stimulatory guanine nucleotide-binding protein was examined and found to have low values. The olfactory tests were performed by T & T olfactometer and intravenous injection of thiamine propyl disulphide. The four patients receiving olfactory test showed a disturbance in recoginzation of the odorants. All five patients had normal hearing at frequencies with the normal range. An adenylate cyclase system is thought to play an important role in olfactory transduction, whereas cochlear function may be unaffected by this system in the normal state.

The possible role of surgical manipulation in inducing local spread and cicatricial complications in rhinoscleroma is illustrated by the three cases discussed in this paper. This is especially so where is occasional presentation as polypoid lesions of the lower respiratory tract may mimic other more sinister lesions and lead to unwarranted invasive procedures by the unsuspecting clinician. The infective nature of the lesions must be appreciated and confirmed microbiologically for appropriate drug treatment to be used. The benefits of minimal surgical intervention are illustrated in the third case.

Symptoms producing small front-ethmoidal encephalocoeles are generally identified radiologically. The examination of choice is coronal CT, eventually performed axially with coronal reconstructions, and best with intrathecal contrast material delineating the basal cisterns. Two case reports demonstrate the clinical and radiological problems in identifying and fronto-ethmoidal encephalocoleles.

This paper present 35 patient with carcinoma of the tongue who have been treated in Southampton using the Carbon laser. The treatment programme for each individual patient was determined by radiotherapists and surgeons in a combined head and neck/oncology clinic. T1 carcinomas were treated by primary laser excision biopsy whereas larger tumours were treated first by conventional radiotherapy unless there was a significant contraindication to this treatment modality.

Of 10 patients with T1 lesions nine are alive and well and disease free, but one patient died of other causes with no sign of recurrence. The minimum follow-up period has been two years. Of 25 patients with T2 and T3 lesions treated either before or after radiotherapy, nine are alive and disease-free, eleven died of disease and five patients died of other causes with no evidence of recurrence.

The dissection of cervical lymphatics for cancer after radiotherapy imposes a special need to ensure good healing of skin flaps with good access and acceptable aesthetic results. Adaptability of incisions for extended surgery is also desirable.

Although it is felt that the adoption of the basic MacFee incision pattern fulfils these criteria, the author has for years employed curved modifications of the two horizontal incision lines. This develops a waisted skin bridge which in freely mobile and gives better access to the deep structures.

The technique is contrasted with other approaches and described in detail. It complies with the safe principle of join-free linear incisions and is practical for regular use.

There are many different flaps available for head and neck reconstruction. The latissimus dorsi myocutaneous flap has been widely used in this unit on 80 occasions in the past three years, both as a pedicled and as a free microvascular flap following the excision of head and neck malignancy, the commonest pathology being intraoral squamous cell carcinoma.

There were nine cases of complete or substantial flap loss requiring a further reconstructive procedure. Few of the patients who underwent total glossectomy suffered from overspill or aspiration and the fistula rate was low.

Reference is made to the anatomy and the technique of raising this versatile flap which provides a large volume of tissue and has been particularly useful following total glossesctomy when combined with a hyoid hitch.

A small group of 46 previously untreated patients out of about 260 in all who have received Price Hill schedule A cytotoxic chemotherapy, achieved apparent complete clinical regression (ACCR) of their disease before local treatment. Forty patients were classified T3 or T4, over half having clinically positive nodes at the start of treatment.

A determine survival rate of 70 per cent disease free at three years was obtained and 74 per cent achieved quality of all symptoms. Two patients declined local treatment and survived three years disease free after chemotherapy alone. No recurrence has occurred to date in seven patients achieving apparent complete histological regression (ACHAR) in their surgical specimens.

Although ACCR does not automatically improve prognosis it is likely that it does enhance the complete remission rate, especially for those also achieving ACHR.

Benefits to patients obtaining ACCR with this minimally toxic chemotherapy schedule and listed.

During the 10-year period 1917–1980, oesophagoscopy was carried out on a total of 3235 patients in the Department of Otolaryngology, Turku University Central Hospital, Finland. Oesophageal carcinoma was diagnosed in 258 patients, 113 (44 per cent) men and 145 (56 per cent) women. The diagnosis was verified in 228 cases (88.4 per cent) by using an optical rigid oesophagoscope and in 30 cases (11.6 per cent) by a fibreoptic endoscope. The most common and earliest symptom was difficulty in swallowing in 50 per cent of cases. In 44 per cent of patients the symptoms persisted over six months before diagnosis. Upper and middle thoracic portions of the oesophagus were the sites of origin of the carcinoma in 57 per cent of the patients. The macroscopic picture obtained by oesophagoscopy was regarded as malignant in 83 per cent of patients and extraoesophageal spread of the tumour was estimated to be present in 48 per cent of patients by the time of diagnosis. Histological studies showed the tumour to be squamous cell carcinoma in 62 per cent of patients and in 24 per cent well differentiated. Squamous cell carcinoma was seen more often in men than in women. In patients with carcinoma in situ, alcohol and tobacco were regarded as aetiological factors in 53 per cent of cases. The need for repeated oesophagoscopy in patients with symptoms related to swallowing is stressed.

Brainstem auditory evoked potentials (BAEP) were recorded in two patients with nasopharyngeal carcinoma (NPC) irradiated 14 and three years ago respectively and compared with 15 healthy controls. The patients had features of post- irradiation myelopathy of the brainstem with reduced gag reflex, unilateral vocal cord paralysis and fasciculation of the tongue. The first patient had a blind left eye. The second patient had quadriparesis. All ears revealed post-irradiation otitis media changes and mixed deafness. BAEP was not recognizable in the left ear of the first patient and was normal in the left ear of the second patient. Simultaneous electrocochleogram and BAEP were recorded from the right ear of the first case. The wave I–V latency interval were rolonged in both right ears. In the absence of local recurrence and brain secondaries, these BAEP changes are attributed to the post-irradiation myelopathy of brainstem.

Primary nasal tuberculosis is rare. We report a case of primary nasal tuberculosis in an elderly lady who presented with symptoms and signs suggestive of a nasal fossa tumour. Histological examination of the lesion revealed the diagnosis. Treatment was with standard anti-tuberculous chemotherapy. The implications of primary nasal tuberculosis are discussed.

A localized amyloid deposit in the nose is extremely rare and involvement of the nose involvement in systemic amyloidosis is presented.

Vascular tumours of the nasal cavity are uncommon and are either hamartomas or ture neoplasms, mostly benign. We present an unusual case of angiomyolipoma of the nasal cavity. The harmartomatous lesion is often described in the kidney and may be associated with tuberous sclerosis. To our knowledge, there is no previous report of the lesion in the nasal cavity, and no association with tuberous sclerosis has been demonstrated in this case.