The surgical management of the pars tensa retraction pocket in the child--results following simple excision and ventilation tube insertion.

Retraction pockets of the pars tensa formed due to poor mesotympanic ventilation can result in chronic infection, ossicular damage and even acquired cholesteatoma. A diversity in opinion exists as to the best surgical treatment of an established retraction pocket. This paper presents a consecutive prospective series of 39 ears managed over the last 4 years by means of simple excision and insertion of a middle ear ventilation tube. The retraction pockets were graded according to Sade's 1979 classification. There were 23 grade II and sixteen grade III retractions. All 39 pockets were successfully excised. Thirty-four of the perforations healed, with the remaining five failing to heal at the time of analysis. In 13 cases the pockets recurred, but in five of these cases the recurrence is minimal and has required no further surgical intervention. Of the eight remaining significant recurrences, four have undergone a repeat procedure with no further recurrence in three cases. Following initial surgery, 67% of the ears operated upon had either minimal or no recurrence. Following further surgery this figure increased to 75%. The air conduction threshold improved by an average of thirteen decibels in those ears that healed with no recurrence.

Why paranasal sinuses?

This essay attempts to address the perennial question 'Why Paranasal Sinuses?'. In doing so it highlights the flaws in many much-favoured but ill-founded theories concerning the role of these sinuses in humans. It is concluded that the question can only be fully answered through a greater understanding of differential growth changes within the craniofacial massif.

Neonatal stridor in association with herpes simplex infection of the larynx.

Herpes simplex virus (HSV) infection in the neonatal period may be confined to the eyes, skin and upper aerodigestive tract or may be widely disseminated to other organs, with particular recognition of involvement of the central nervous system (CNS) causing herpes encephalitis (Whitley et al., 1980a, b; Andersen, 1987). Primary laryngeal HSV infection is extremely uncommon. We present a case of acute neonatal stridor secondary to such localized disease and discuss its management.

Does receiving a copy of correspondence improve patients' satisfaction with their out-patient consultation?

It is standard practice to write to a patient's general practitioner (GP) following an out-patients consultation. This study set out to assess whether sending a copy of this letter to the patient improves their satisfaction with the consultation. Two hundred patients were randomly assigned to receive or not to receive a copy of their GP letter. Their satisfaction was then assessed by means of a postal questionnaire. The two groups were compared to ensure that their was no significant difference between them with regard to any other aspect of their consultation. Those who did not receive a copy letter had a median overall satisfaction score of 7.75 whilst those who did had a median score of 9.0 (p = 0.014). The only other factors predictive of overall satisfaction were receiving an explanation of the problem and spending sufficient time with the doctor. Sending patients a copy of correspondence to their GP is one means of aiding communication and improving overall satisfaction.

Scaling properties of the frontal sinus in the African great apes--a clue to the role of the human paranasal sinuses.

The biology of scaling (allometry) can prove a useful tool in comparative anatomical studies. Amongst primates only the African Great Apes and Man possess a frontal sinus. The aim of this study was to identify the allometric properties of the frontal sinus in order to gain clues as to the role of the human paranasal sinuses. A measure of frontal sinus volume was calculated for fifty-seven Great Apes and then scaled against indicators of body size and nasal cavity volume. The results suggest that there are racial variations in frontal sinus size in the African Great Ape populations. This phenomenon mirrors the human condition. The scaling relationships identified in the study lend support to the hypothesis that the frontal sinus has a "structural" rather than a "functional" role.

CT scanning in "second look" combined approach tympanoplasty.

One of the main disadvantages of intact canal wall mastoid surgery for cholesteatoma is the necessity of the "second look". The morbidity of a second procedure can be reduced, however, with the aid of a rigid endoscope. Fifty-five consecutive patients undergoing a re-exploration were included in this study. Prior to surgery computerized tomography (CT) was performed in order to assess both the anatomy and degree of pneumatisation of the middle ear cavity and mastoid bowl. The operative findings at the time of the "second look" were correlated with the pre-operative scans. An otoendoscopic approach was possible in all cases. In the diagnosis of residual or recurrent disease, the CT scan had a sensitivity of 43.8%. The specificity of the CT scan was 51.3%. The explanation for these findings is that it is impossible to differentiate between recurrence, scar tissue or inflammation on CT images in patients who have undergone previous mastoid surgery.

An allometric study of the frontal sinus in Gorilla, Pan and Pongo.

There is considerable speculation about the role and significance of the paranasal sinuses in the Hominoidea, and this study aims to present new data about an old problem from cephalograms of dried crania. Measurements of frontal sinus volumes were determined for Gorilla gorilla gorilla; G. gorilla beringei and Pan troglodytes. By adopting an allometric approach it was determined that the frontal sinus volume of Gorilla is relatively smaller than that of Pan, and that the frontal sinus of G. g. gorilla is relatively smaller than that of G. g. beringei. Frontal sinus volume scales in a positive allometric fashion relative to skull length. Since the slope is steeper for Pan, frontal sinus volume is increasing at a faster rate than in Gorilla. Sexual dimorphism in frontal sinus volume is present. Thirty crania of Pongo were investigated for evidence of pneumatization of the frontal bone. In no case was secondary invasion of the frontal bone by the maxillary antrum observed. In Gorilla, the nasal cavity volume scales isometrically with skull length. The scaling relationships discussed do not support any 'functional' role of the frontal sinus associated with nasal function but suggest a 'structural' role associated with craniofacial architecture.

Technique for reconstituting fixed cadaveric tissue.

Dissecting room cadavers used over a prolonged period inevitably become desiccated, especially in well-ventilated surroundings. It is particularly desirable that dissections used for end-of-year examinations be restored to their original condition. We describe here a quick and simple procedure designed to restore neglected specimens to their former condition at dissection. Specimens were either soaked for 24 hr in a standard solution of fabric conditioner or sprayed with the same standard solution. The specimens were then wrapped with muslin soaked in the conditioner and covered with polythene sheeting for 1 week. The results obtained were excellent and much superior to a short soak in water. The results further indicate that this technique may have other applications in the preparation of fixed histological material.

An assessment of the value of the preoperative computed tomography scans prior to otoendoscopic 'second look' in intact canal wall mastoid surgery.

'Second look' surgery following primary intact canal wall mastoid surgery for cholesteatoma is considered mandatory for most cases in modern otological practice. The morbidity of the second look can be reduced by the use of the rigid otoendoscope. Forty-three patients undergoing 'second look' surgery were studied with an average age of 24.7 years. Prior to surgery a computed tomography (CT) scan was performed to assess the anatomy and pneumatisation of the cavity. The mean interval between primary and secondary surgery was 16 months and in all cases CT scans were performed within 6 months of 'second look' surgery. The presence of an opaque mastoid did not correlate with residual or recurrent cholesteatoma. The sensitivity of CT in diagnosing residual or recurrent cholesteatoma was 42.9% with a specificity of 48.3% and a predictive value of 28.6%. These results are explained by the fact that it is radiologically impossible to differentiate between recurrence, scar tissue or fluid with a CT scan. Nevertheless it was possible to inspect the cavity with the otoendoscope even in the presence of an opaque mastoid whether due to scar tissue or residual/recurrent cholesteatoma.