The surgery of congenital deafness.

This paper outlines the indications for surgery of congenital deafness in complete meatal aplasia, the methods of audiological and radiological assessment and an operative technique used in ten ears. It is felt that otologic surgery should be done before the pinna reconstruction as it is very important to try and introduce sound into these children at an early age. In addition, the position of the new auricle can be made more satisfactorily around an already established meatus. The value of tomography of the internal as well as the middle ear is stressed and the necessity for providing a stable and uninfected meatus emphasized with regard to the possible fitting of a hearing aid.

Pharyngeal pouch carcinoma: two unusual cases.

Two patients with carcinomata arising in pharyngeal pouches are reported. In one, the tumour was detected preoperatively by a contrast radiographic study. In the second the lesion was a carcinoma in situ. The English literature is reviewed with reference to these two unusual features.

Long-term results of submandibular duct transposition for drooling.

This study examines the long-term results and morbidity of submandibular duct transposition in drooling children. Twenty-two patients, aged 3 to 18 years, with neurological dysfunction and excessive drooling underwent submandibular duct transposition between 1984 and 1987. In January 1990, 20 patients were reviewed. Their degree of drooling pre-operatively, immediately post-operatively and currently was assessed. The rate of improvement and the occurrence of complications were noted. Drooling was 'much better' in the early post-operative period in 17 of the 20 patients, and this improvement was invariably noted within three weeks. In the three other patients drooling was 'better'. Deterioration occurred in only three patients over the entire follow-up period. Complications all occurred in the first 18 months following surgery; they consisted of salivary retention cysts in four and transient submandibular gland swelling in a fifth patient.

Swallowing in motor neurone disease.

Ninety-two patients with motor neurone disease have been assessed clinically and radiologically for evidence of swallowing problems. At the time of examination, moderate or severe swallowing difficulty was present in 89% of those whose disease had presented as bulbar palsy, in 45% of those in whom the disease began many months before as progressive muscular atrophy and in 29% of those with amyotrophic lateral sclerosis. Patients with more severe swallowing symptoms appeared more likely to have abnormal findings on videofluoroscopy overall. However, not all patients with an abnormal radiological picture had swallowing difficulties. It is suggested that radiological signs should only be used within the context of clinical symptoms and signs in the selection of patients for palliative surgery. Thirteen patients with pseudobulbar symptoms and signs had a cricopharyngeal myotomy performed: two suffered major post-operative complications. However, the satisfaction rate was 89% and we recommend cricopharyngeal myotomy for such patients. Pharyngostomy was performed for seven patients unable to initiate swallowing, six had post-operative complications.

The surgery of congenital deafness. The Oxford, England series of 235 ears.

This paper outlines the indications for surgery of congenital ears in complete meatal aplasia and an operative technique used in 35 ears. It is felt that otologic surgery should be done before the pinna reconstruction as it is very important to try and introduce sound into these children at an early age. Most of the patients in this series were 2 to 3 years' old. In addition, the position of the new auricle can be made more satisfactorily around an already established meatus. The value of radiology of the internal as well as the middle ear is stressed and the necessity for providing a stable and uninfected meatus emphasised with regard to the possible fitting of a hearing aid. Failure to achieve a permanent unaided hearing improvement is due to fibrosis at the bottom of the meatus, a problem which is yet to be solved.

A review of 50 cases of intracranial complications from otogenic infection between 1961 and 1977.

The records of 50 patients with intracranial complications of middle ear disease treated over the past 16 years have been reviewed. Virtually all the known intracranial consequences of middle ear infection have been encountered, and include cerebral abscess, cerebellar abscess, meningitis, lateral sinus thrombosis, otitic hydrocephalus and cortical thrombophlebitis. The clinical features, neurological signs and investigative data for each group have been compared and contrasted. Treatment in the past has consisted of radical and modified radical mastoidectomy. It is proposed that these techniques will continue to be preferred for the management of chronic otitis media in the presence of a condition as serious as an intracranial complication. It is concluded that with a quoted incidence of postoperative cholesteatoma as high as 40% intact canal wall techniques are not justified in these patients at present.

Factors influencing the preservation of the facial nerve during acoustic surgery.

We reviewed the last 30 acoustic neuromas excised in our department and attempted to find out the factors associated with preservation of the facial and cochlear nerves. While the size of the tumour was the most important factor, vascularity and consistency were both important. Facial and cochlear nerves were preserved in 63% and 10% of the patients respectively. The importance of early diagnosis cannot be overemphasized.