Decibel scales are a very important but potentially confusing subject for the clinician. Misunderstanding can, at worst, lead to inappropriate management which is detrimental to the patient. This paper sets out, from the viewpoint of an acoustician, the calibration and meaning of the various decibel scales in common use, shows how they are applied to the clinical setting, and explains their limitations.

People with profound deafness were surveyed in the general population of Sichuan. The results showed that the overall prevalence in Sichuan was 0.186 per cent (236/126 876) of the general population, males 0.2 12 per cent (135/63 741), females 0.159 per cent (101/63 135) (p 0.05). Two hundred and fifteen (92 per cent) cases were older than 10 years, but 227 (96 per cent) lost their hearing under the age of 10 years, 192 (80 per cent) under five years, and 104 (44 per entwere congenital). There was no significant difference in prevalence of deafness between the population located in urban and rural areas. However, the population living in the flat area and mountain area had a much higher prevalence than that of the hill people (p 0.05). Amongst the nationalities investigated, there existed significant differences in prevalence. Both the population of the Hui and the Lisu presented a significantly higher prevalence of profound deafness than that of the others. In aetiology, genetic factors may account for 43 per cent (101/236) of the cases, amongst which, autosomal recessive (AR) deafness is 92 per cent (95/104) and autosomal dominant (AD) 5.4 per cent. Environmental factors were thought to be responsible for 35.6 per cent (84/236) of cases, including infectious diseases (31 per cent), ototoxic antibiotics (2.6 per cent), injury (1.7 per cent), and asphyxia (0.4 per cent). The number of cases of unknown origin were 20.3 per cent. It is suggested that, in China, the importance of genetic factors in hearing impairment should be emphasized. In addition, infectious diseases and ototoxicity play an important role in causing deafness.

Antibodies to type II collagen have been reported by some authors to be raised in patients with Ménière's disease. In this study the antibody levels to type I and II collagen have been measured in 37 patients with Ménière's disease and 20 controls, using a solid-phase, double-antibody, enzyme-linked, immunoassay. No significant difference in antibody levels between the two groups was found. These findings do not support previously reported work which suggests that some cases of Ménière's disease are due to type II collagen autoimmunity.

During the eight-year period, 1983–1990, 102 cases of intracranial (IC) and extracranial (EC) complications from 17 144 suppurative otitis media were reviewed. The prevalence of each complication was 0.24 and 0.45 per cent respectively. Facial paralysis, subperiosteal abscess and labynnthitis were the common complications among the EC group, while meningitis and brain abscess were common in the IC group. Twenty five per cent of the EC group and 44 per cent of the IC group had more than two complications. The reliable warning signs and symptoms for IC complications were fever, headache, earache, vestibular symptoms, meningeal signs and impairment of consciousness. Proteus spp., Pseudomonas aeuruginosa and Staphylococcus spp. were the commonest organisms isolated from both groups. Cholesteatoma and granulation/polyp in the middle earl mastoid were the major findings in both patient groups. Mortality rate in the IC group was 18.6 per cent. Morbidity rate in each group was 14.3 per cent (EC) and 27.9 per cent (IC) respectively. Epidemiological presentations, clinical features and the result of treatment are discussed.

Cases of intracranial sepsis of otorhinogenic origin presenting to a regional neurosurgical centre from 1984 to 1992 were examined with regard to their microbiology and antibiotic sensitivities. The results lead us to believe that cefotaxime may have a role in the initial ENT management of the potentially complicated case of ear or sinus sepsis.

Thirteen patients suffering from primary hypogammaglobulinaemia receiving intravenous immunoglobulin replacement therapy underwent computerized tomography of the paranasal sinuses. The CT scans were evaluated and related to clinical data from the patients, who were selected for study on the basis of having symptoms of rhinosinusitis. The scans varied from normal to demonstrating widespread sinus abnormality. Th.ere was no relationship between the scan findings and duration of ENT symptoms, range of current symptoms, or the interval between the onset of ENT symptoms and the start of intravenous immunoglobulin replacement therapy. It is nevertheless possible that prompt institution of replacement therapy, after correct diagnosis early in the course of the disease, may prevent the development of sinus disease refractory to such treatment.

Some patients complain of altered sensation in the mouth following nasal surgery. A prospective study of 60 consecutive patients who underwent a total of 83 intranasal procedures revealed that this was a common complication, particularly following submucous resection (SMR) or intranasal antrostomies.

The area affected by painlparasthesia appears to be anatomically related to the surgical procedure(s) performed.

Carcinoma in Situ (CIS) of the glottis is an uncommon and poorly understood condition with few, large, long- term studies. Twelve cases are presented which were treated with radiotherapy. At three-year follow-up all the patients are disease free and in 83 per cent the mucosa has returned to normal. The alternative methods of treatment are discussed.

In order to elucidate the causal mechanism of trismus in head and neck cancer, 21 patients manifesting trismus out of 212 patients with malignant tumours in the head and neck (treated in Tokyo University Branch Hospital from 1983 to 1991) were reviewed. Nine patients developed trismus either by infiltration of the muscles of mastication or by reflex spasm. Trismus was considered to have developed as a result of irradiation in five cases and of surgical intervention in seven cases. In some cases of oropharyngeal cancer, CT revealed no evidence of tumour invasion into the infratemporal fossa when trismus occurred, suggesting that trismus was caused either by the reflex spasm of muscles or by microinvasion too small to be seen in CT films. Maxillary sinus tumours were often without tnsmus even when they extended posteriorly to the infratemporal fossa.

Gastric pull-up is a reliable method of one-stage reconstruction following total laryngopharyngoesophagectomy (TLPE). However, the technique of blunt finger dissection for extrapleural extraction of the oesophagus is liable to produce chest complications like pneumothorax. We report a series of 45 patients who underwent gastric pull-up using the technique of oesophageal extraction by stripping which produced virtually no thoracic complications. This simple technique has greatly reduced morbidity associated with gastric pull-up.

This paper describes the application of fine needle aspiration cytology (FNAC) performed on92 patients with salivary gland lesions in a Head and Neck Surgery Clinic. The aspirates were immediately reported by a cytopathologist and the reports conveyed to the surgeon during the same clinic visit. FNAC results were then compared with histology in those patients who underwent surgery and with the clinical course of the disease at subsequent clinic visits in patients where surgery was not performed. The cytological diagnosis was incorrect in five cases, one of which was a false negative result. There were no false positive results. The sensitivity was 90.9 per cent and the specificity 100 per cent. This rapid report system of fine needle aspiration cytology has been found to be safe, free of complications, and helpful in the planning of treatment.

A meatoplasty technique is described which has proved successful in the treatment of chronic otitis externa. The procedure opens the superficial meatus by eliminating the sharp rim at the junction of the conchal bowl and the posterior canal wall cartilage; thinning the skin and increasing the circumference of the external auditory orifice.

An improved technique for fixation of a Foley catheter in posterior epistaxis is presented. It has the advantage of rigidity combined with a narrow diameter.

A case of neurobrucellosis presenting to the otologist with sensorineural hearing loss (SNHL) as the predominant clinical feature is reported. The diagnostic features and treatment options are discussed and the need for prolonged combination treatment to prevent relapse and further deterioration of hearing stressed. SNHL in neurobrucellosis has hitherto been reported principally in neurology literature as something of an incidental finding and so escapes the attention of otologists. It is hoped that this report will alert otologists in areas where brucellosis is endemic to the need to include tests for brucellosis in the routine diagnostic screening for SNHL. Practitioners in other locations should also consider this possibility when dealing with patients who have visited or lived in endemic regions.

Vascular anomalies, extracranial and intracranial arteriovenous malformations as well as glomus jugulare tumour are well known causes of pulsatile tinnitus. Of late, benign intracranial hypertension has been stated to be a more common cause. However, tinnitus arising from and within the internal jugular vein has been reported only infrequently. Previously known as cephalic bruit and essential objective tinnitus, the venous hum tinnitus presents as pulse synchronous unilateral objective tinnitus. Ligation of the internal jugular vein appears to be a successful treatment. Two cases are presented.

A report of a case with a vascular malformation of the internal auditory canal (IAC) is presented. A review of the literature of this rather rare lesion is also made in an attempt to outline its clinical features, radiological diagnosis and management. The differential diagnosis and distinction between vascular malformations and other internal auditory canal tumours are discussed.

Orbital complications of ethmoiditis are not uncommon in children. They are, however, much rarer in the very young. A case is presented in which a neonate of gestational age 39 weeks developed a periorbital abscess. The relevant literature is reviewed with respect to embryology, aetiology and treatment.

The melanotic neuroectodermal tumour of infancy is a rare, pigmented neoplasm that most frequently arises from the anterior maxillary alveolar ridge. It presents in the first few months of life, and usually follows a benign course. A classical case is presented and the clinical, radiological and pathological characteristics are discussed. The importance of early conservative surgical excision is emphasized with, in general, a good prognosis.

This tumour, which many otolaryngologists may not be familiar with, should be included in the differential diagnosis of head and neck neoplasms in infants and young children.

A case of IgD myeloma in a 54-year-old male with a long-standing history of extramedullary plasmacytoma involving the larynx is reported.

The patient was treated with radiation therapy and laryngectomy. Twelve years later, he complained of nasal bleeding. On examination he was found to have large masses in the left nasal cavity and in the left supraclavicular region. Histological examination of both lesions showed plasmacytoma. Serum immunoglobulin studies revealed an IgD monoclonal spike of the lambda type. Bence-Jones protein was present. Using the immunoperoxidase staining technique, cytoplasmic monoclonal IgD was detected.

We report a case of primary tracheal tuberculosis that presented with a hard, fixed lymph node in the right supraclavicular fossa, and progressive dysphagia due to an inflammatory mass caused by a tuberculous lesion in the trachea. This case underlines the old adage that tuberculosis is ‘the great masquerader”.