Inorganic fluoride concentration after long-term sedation with isoflurane.

We report on five patients in whom long-term sedation with isoflurane for up to 7 days was used successfully. Serum inorganic fluoride concentrations were measured daily. The concentrations ranged from 12 mmol l-1 to 29 mmol l-1. These were well below the described renal toxic level of 50 mmol l-1. There was no deterioration in renal function attributable to the use of isoflurane.

Cancer of the paranasal sinuses and nasal cavities. Part II. Results of treatment.

Part I of this account of a large consecutive series of 561 patients with cancer of the paranasal sinuses and nasal cavities treated at the Royal Marsden Hospital reveals some significant clinical and radiological features. The histopathology of every case has been carefully reviewed by one pathologist. Carcinoma was found to account for almost 80 per cent of tumours. An account is given of treatment methods in present use. End-results are reported in Part II of the paper and demonstrate that patients with sinus cancer receiving combined treatment in one centre have a better prognosis than when it is given in two or more hospitals. The discussion also concentrates on the use of main treatment methods and emphasizes some advances in surgical techniques. The value of initial cytotoxic chemotherapy is unproven but may offer some further advantage in prognosis. Precise comparison with the results of other series is not possible owing to lack of agreement on classification, variable case selection and differing treatment techniques.

Tympanic membrane mobility on otoscopy as an indicator of eustachian function.

Three hundred and twelve ears in 156 subjects were assessed. All the subjects were recruit volunteers to the Submarine and Diving branches of the Royal Navy, who were unable to equilibrate their middle ear pressures when exposed to an environment of increased ambient pressure. All these subjects were found to have a deformity of the vomero-ethmoid suture and underwent submucous resection of the nasal septum to correct their Nose-Ear Distress syndrome. Six weeks after operation each recruit was re-assessed otologically; 29 subjects (18.6%) had bilaterally immobile tympanic membranes and 6 subjects (3.9%) had an unilaterally immobile tympanic membrane on performance of Valsalva and Toynbee maneuvers. Nevertheless, 26 subjects (74.3%) were able to equilibrate their middle ear pressures at a depth equivalent to 10 meters of water. Because of this finding it can be stated that immobility of the tympanic membrane on performance of the Valsalva and Toynbee maneuvers does not necessarily denote the presence of eustachian tube dysfunction.

Otitis media with effusion in children and its association with deformity of the vomero-ethmoid suture.

Fifty children aged between five and eight years of age who have had proven otitis media with effusion have been retrospectively assessed. Twenty-five children who had attended the Casualty Department with head injuries, who have had X-radiography of their skulls as part of their investigation, acted as controls. All the children in this group were selected because they had no otological history. The 50 children comprising the retrospective survey were split into two groups: Group 1, with recurrent secretory otitis media requiring surgical intervention on more than three occasions; Group 2, comprising 25 children who had had up to three surgical interventions. All the children had PA X-radiography of their skulls in order to demonstrate the bony nasal septum. In Group 1, a septal deformity was found to be sited at the middle third of the bony septum at the vomero-ethmoid suture. In Group 2, the deformity was found to involve the whole of the middle third of the bony septum, plus portions of the upper and lower thirds of the bony septum. In the control group, in whom there was no history of otological disease, there was no deformity sited at the middle third of the bony septum.

Eustachian tube dysfunction in submariners and divers.

Fifty-four recruit volunteers to the submarine and diving branches of the Royal Navy, and 35 nonvolunteers to the submarine branch who acted as control subjects, had their conditions assessed. All were unable to attain middle ear pressure equilibration when exposed to an increase in ambient pressure of 3 m H2O in the compression chamber. All the subjects suffered from the nose-ear distress syndrome, which is defined as the combination of Eustachian tube dysfunction and septal deviation in the absence of any other pathological conditions, The volunteer group were submitted to submucosal resection of the nasal septum, while the nonvolunteers were treated conservatively. Six weeks after operation 51 subjects (94.4%) who had had a submucosal resection were able to equilibrate their middle ear pressures at 10 m H2O. All the nonvolunteer group failed to equilibrate at 3 m H2O.

Middle-ear analysis in the nose/ear distress syndrome.

The Nose/Ear Distress Syndrome is defined as 'the combination of nasal septal deformity and eustachian dysfunction in the absence of any other pathology' (McNicoll and Scanlan, 1979). One hundred and two recruits to the Submarine, Diving and Aircrew branches of the Royal Navy, who at initial assessment had been found to have an intact, immobile tympanic membrane, when the Valsalva, Toynbee or Politzer manoeuvres were performed, were referred to the ORL Department, Royal Navy Hospital, Haslar, for further assessment as to their ability to serve in environments of primarily increased ambient pressure. Forty-two qualified members of the Submarine and Diving Branches acted as controls, as they were known to have positive eustachian function, and also clinically mobile tympanic membranes on performance of the Valsalva manoeuvre. Both groups underwent middle-ear analysis, using a Grason Stadler 1723 Middle-Ear Analyser, which has an additional facility for testing eustachian tube function. Those subjects not in the control group were subjected to an increase in ambient pressure in the compression chamber at HMS Dolphin. The ability to equilibrate an increase in ambient pressure of 10 metres of water was regarded as the ultimate criterion of positive eustachian function, those who were unable to do this were diagnosed as suffering from the Nose/Ear Distress Syndrome.

Remediable eustachian tube dysfunction in diving recruits: assessment, investigation, and management.

Many individuals who wish to become divers for either social or professional reasons are prevented from partaking in their chosen activity because they are unable to equilibrate their middle ear pressures when they are exposed to an increase in ambient pressure. Thirty-seven male subjects, serving members of the Royal Navy who wished to become divers but were unable to equilibrate their middle ear pressures when exposed to an increase in ambient pressure, were investigated clinically and underwent nasal septal surgery. Six weeks after operation, 34 subjects were able to to equilibrate their middle ear pressures at a depth equivalent of 10 m (33 ft) of water.

Submucous resection. The treatment of choice in the nose-ear distress syndrome.

The combination of nasal septal deviation and Eustachian tube dysfunction, in the absence of any other pathology, constitutes the Nose-Ear Distress Syndrome. We have undertaken a clinical assessment of the relationship between uncomplicated deviation of the nasal septum and Eustachian tube dysfunction in Naval Personnel who are serving in environments of primarily increased barometric pressure. 120 candidates to the Submarine, Diving and Aircrew branches of the Royal Navy who presented with the Nose-Ear distress syndrome were initially surveyed. None were able to equilibrate their middle ear pressures at an increased ambient pressure of 3 metres of water. Submucous resection was performed on 116, of whom 110 (94.83 per cent) were able to equilibrate their middle ear pressures at an increased ambient pressure of 9 metres of water post-operatively. Xenon 133 Scintigraphy was performed on a further 25 recruits to delineate the post-nasal airflow. This investigation was performed pre- and post-operatively. Pre-operatively, Scintigraphy showed the presence of turbulence in the post-nasal space, while post-operatively the turbulence was absent. All the candidates were unable to equilibrate their middle ear pressures pre-operatively, but after submucous resection 24 (96 per cent) were able to equilibrate their middle ear pressures at an increased barometric pressure of 9 metres of water.