One hundred and thirty patients with acute-on-chronic mastoiditis were managed by the ENT Department of Groote Schuur Hospital between 1980 and 1984 inclusive. Seventy-four patients had cholesteatomas, of whom 78.4 per cent had intracranial extension and 44.6 per cent had intradural extension of the infection. In contrast, of the 56 patients without cholesteatomas, only 23.2 per cent had intracranial extension of the infection. These may be rare conditions in some privileged parts of the world but their lethal potential requires all ENT surgeons to be competent in their management.

One hundred and thirty patients with acute and acute on chronic mastoiditis were managed at Groote Schuur Hospital between 1980 and 1984. Twenty-two (16.9 percent) had pathology of the lateral (sigmoid) sinus and 19 of these patients had cholesteatomas. Nine patients (40.9 per cent) had concomitant intradural sepsis and there were two deaths.

The modern literature is reviewed and the pathology, presentation and management of lateral sinus pathology is discussed. This condition is rare and clinical features may range from subtle signs to gross toxaemia, torticollis and evidence of septic embolization. The otolaryngologist must be competent in diagnosing and treating this condition in all forms of its wide spectrum of presentation.

Thirty-six children with bilateral secretory otitis media were treated by thermal myringotomy and middle ear aspiration in one ear, and conventional myringotomy, middle ear aspiration and Shepard grommet insertion in the other ear. All children underwent adenoidectomy. Comparing the effectiveness of the two different procedures over a three-month review period, our main findings are as follows. All thermal perforations were closed by 42 days. Elimination of middle ear fluid was achieved in 81 per cent of the thermal myringotomy group, and in 100 per cent of the grommet group. While there was no significant difference in the hearing improvement between the procedures, conventional myringotomy and grommet insertion provided significantly better sustained middle ear ventilation.

Our pilot study reports twenty-six cases of resolved chronic otitis media in which the human, cadaveric styloid process was used as an ossicular graft material. A maximum follow-up of one year is presented in this paper. There was no extrusion or rejection of the styloid processes. Hearing improvement with a closure of the air-bone gap to within 10–15 dB. of the pre-operative bone conduction was found in most cases. So far the styloid process has proved to be an ideal ossicular graft though the long-term results are yet to be seen.

The major features of the Branchio-Oto-Renal syndrome (BOR syndrome), an autosomal dominant disorder, are branchial remnants, ear anomalies, deafness and renal dysplasia.

We report two family groups affected by the BOR syndrome: in two-thirds of the affected children renal abnormalities led to severe renal insufficiency in early life. The necessity for a meticulous search for renal anomalies in individuals with aural and/or branchial abnormalities is emphasized. In affected families, genetic counselling is suggested.

A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.

Although exostoses of the external auditory canal are not uncommon, those of the internal canal are extremely rare. One of these is described occurring in a 53-year-old man whose rapidly progressive hearing loss was without any associated abnormality.

Two cases of chondrosarcoma of the maxilla are reported together with the clinical and histological differential diagnosis. The origin of this rare tumour in the maxilla, a bone with exclusive membranous ossification, is discussed in accordance with the new concept of cell differentiation in neoplasia.