In-the-ear hearing aids within auricular prostheses.

We report a child with bilateral congenital microtia in whom cosmetic and auditory rehabilitation has been effected using in-the-ear hearing aids within prostheses overlying the rudimentary external auditory meati after canaloplasty. This novel method of auditory rehabilitation has not been reported before and is suitable in selected cases. The prostheses themselves were successfully secured using a prosthetic contact adhesive we have developed that offers excellent retention, little if any skin reaction, and high patient acceptability.

Results of middle ear ventilation with Goode's tubes.

The results of a retrospective study of the effect and outcome of middle ear ventilation by Goode's tubes are presented. 83 ears from 50 patients were analyzed both as a group and in age-related sub-groups over a mean follow-up period of 1.83 years. The mean period of ventilation by Goode's tubes before removal or extrusion was 18.4 months. The tubes became infected in 70.4% and were spontaneously extruded in 44.9% of patients. Permanent perforation of the tympanic membrane ensued in 47.5% of patients and significantly more often in those aged between 10 and 20 years (P less than 0.002). Patients aged less than 10 years were significantly less likely to develop a retraction of their tympanic membranes after removal of the Goode's tube than those older (P less than 0.02). No significant relationship was found between the development of these complications and the period of ventilation, past experience of otitis media, consistency of effusion, degree of tympanosclerosis or the preoperative presence of tympanic retraction.

Fine needle aspiration biopsy of neck lumps in a district hospital.

This paper examines the results of 117 fine needle aspiration biopsies performed on head and neck lumps over the first 3 years of its use in a district general hospital. The cytological diagnosis has corresponded exactly with the histological diagnosis in 51% of cases and the concurrence rate has been 84%. Fifty-seven (49%) of the 117 masses proved to be malignant and 79% of these were correctly diagnosed by needle biopsy. A further 12% of the aspirations were highly suspicious of malignancy. There were no false positive aspirations (specificity 100%) and 4 false negative results (sensitivity 93%). No complications were encountered.

The stuffy nose: a comparative study of two common methods of treatment.

This study compares the efficacy of submucosal diathermy and cryotherapy in the treatment of nasal obstruction caused by engorged inferior turbinates. Subjectively they are equally effective but cryotherapy has the advantage that it can be performed under local anaesthetic and does not require hospitalization. Rhinomanometry suggests that cryotherapy causes more destruction of the submucosal vascular plexus than submucosal diathermy. Scanning electron microscopy 6 weeks postoperatively demonstrates that both treatment modalities cause widespread damage to the mucociliary epithelium.

Assessment of nasal airway patency: a comparison of four methods.

Two established methods (active posterior and passive anterior rhinomanometry) and 2 new methods (peak nasal inspiratory flow rate and apparent nasal volume) were used in 12 volunteers to assess the patency of the nasal airways under each of 4 conditions (baseline, post-exercise, nasal histamine and nasal cocaine). All methods showed the congestant effect of histamine but the peak nasal inspiratory flow and apparent nasal volume techniques were more sensitive to the 'decongesting' manoeuvres, (exercise and cocaine). Useful objective quantitative data on the patency of the nasal airways and its changes in response to stimuli can be obtained by simple, cheap and readily available techniques. Subjective sensation is a poor guide to the state of patency of the nasal airways.

Fibre optic guided nasal intubation--shouldn't we be the experts?

Difficult intubations are more common in otolaryngological practice than any other branch of medicine or surgery. The majority of these are predictable. It is the unexpected intubational failure, usually in a patient undergoing treatment for an unrelated problem, that results in tragedy. In this paper the indications for fibre optic guided intubation are discussed, and the technique described and illustrated in a case of pharyngeal obstruction secondary to an epiglottic cyst. It is suggested that our expertise to operate within the upper airway should be exploited to the advantage of our patients, and of our anaesthetic and surgical colleagues.

Post-tonsillectomy secondary haemorrhage.

This paper compares the incidence of secondary haemorrhage in post-tonsillectomy patients who were discharged 48 hours after operation (2.8%) with those discharged at 24 hours (3%). There was no significant difference between the groups. A higher incidence of secondary haemorrhage in those patients in whom diathermy was used for haemostasis rather than ligatures (P less than 0.01) supports previous studies.