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.

Minoan civilization was one of the civilizations of the past and flourished in the island of Crete between the years 2600 B.C. and 1100 B.C. Archaeological excavations brought to the light buildings and items, showing that the Minoans had an extensive knowledge about hygiene and health matters.

Among the items were idols, depicting anatomical parts of the human body and different pathological changes. These idols were offered by suffering people to gods and goddesses in order to beg for their help in curing them.

In a study carried out on idols kept in the Heraklion Museum, a number of interesting anatomical details and pathological changes, concerning the head and neck area were recognized.

Hearing loss as a frequent complication of louse–bome epidemic typhus fever has been well documented in the reports of ENT specialists serving in both the Allied and the German armies in the last war. The present paper describes the characteristic histopathological features as noted in sections of the temporal bones from five British soldiers who died in 1944 of typhus fever during the last war in Eastern Asia. The VHIth nerve showed multiple ‘typhus nodules’ and there was extensive interstitial neuritis of the VHIth nerve and demyelination of the nerve fibres. There were also widely scattered aggregations of mononuclear cells in the inner ear.

This unique study was based on the Hallpike collection of temporal bone sections.

A new animal model of ototoxicity is presented using intravenous carboplatin in adult chinchillas. A range of physiological and morphological effects was produced using doses calculated from the recommended therapeutic range (200–400 mg/m2). Auditory thresholds to tone pips stimuli were monitored using brain stem evoked responses (ABR). Cochlear histopathology was studied by light microscopy (LM) and ultrstructural hair cell abnormalities investigated with scanning electronmicroscopy (SEM). Carboplatin in this animal model predominantly affected the inner hair cells. This may provide an important model for the study of selective loss of the main afferent input in the auditory system.

The traditions of the healing of deafness associated with the Celtic saints in Brittany and Wales are discussed. Many more have survived in Brittany because of the religious continuity in that country. Three Saints Cadoc (of Welsh origin), Egarec (of Irish origin) and Meriadec (of Breton origin) are associated with such traditions in a number of different locations.

The relationship between diabetes and senbsorineural hearing loss has been disputed. This study compares 44 insulin-dependent diabetics with 38 age and sex matched controls. All had pure tone and speech audiometry performed, with any diabetics showing sensorineural deafness undergoing stapedial reflecx decat tests. In 14 diabetics stapedial reflex tests showed no tone decay in any patient, but seven showed evidence of recruitment. Analysis of vaiance showed the diabetics to be significantly deafer than the control population.The hearing loss affected high frequencies in both sexes, but also low frequencies in the male. Speech discrimination scores showed no differences. Further analysis by sex showed the males to account for most of the differences. Analysys of the audiograms showered mostly a high tone loss. Finally duration of disbetes, insulin dosage and family history of diabtes were not found to have a significant effect on threshold.

Fifty-nine unusual cerebello-pontine angle tumours have been studied. These lesions represent 19.3 per cent or 1 in 5 of a series of 305 cerebello-pontine angle tumours of which the rest, 246 (80.7 per cent), were acoustic neuromas. An analysis of the relative incidence, histology and presenting clinical features has been carried out. The various radiographical features and imaging techniques used to diagnose these fascinating tumours have been described and also the otoneurosurgical procedures necessary to excise them.

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.

Despite a considerable amount of discussion and research in the course of many years, aural cholesteatoma has remained a matter of controversy. This review concerns only the definition, terminology and pathology of this common and severe disease.

Audit of the incidence of persistent perforation of the tympanic membrane following T-tube removal or extrusion was carried out on 100 patients (151 ears). The incidence was found to be 11.9 per cent. This was independent of whether the tube was surgically removed or extruded; of the grade of surgeon carrying out the operation; and whether the patient treatment was carried out privately or on the N.H.S. Changes of practice have resulted from the audit.

The objective of this paper is to compare two methods of predicting the level of subjective patient benefit following reconstructive middle ear surgery. This should have always been an important consideration in advising patients regarding surgery, but assumes even more relevance in these days of clinical audit and cost benefit analysis. The two methods studied were the ‘15/30 dB rule of thumb’ (Smyth and Patterson, 1985) and the ‘Glasgow plot’ (Browning et al., 1991). The predictions of benefit for each of the two methods were compared to the assessment of actual benefits by the patient post-operatively. The results of this comparison in 153 patients were analysed, the rule of thumb was found to be somewhat more sensitive in predicting patient benefit.

Patients want to know more about their condition and its proposed treatment. Gaining patients' confidence before treatment reduces the chances of their seeking legal redress for an unexpected outcome. As part of a prospective study of informed consent for surgery we have assessed the attitudes of patients towards informed consent when different types of consent interview are used.

We found that most patients are happy to do as their doctor advises but think the informal consent interview is important because it gives them information; they also want to know about most, but not all, complications of the procedure. One quarter worried about the anaesthetic, about one eighth worried about ‘not waking up’ nd similar proportions worried about complications and other things such as pain and nausea. Most patients think that the consent form is a legal document.

In addition patients who had an informal interview felt obliged to sign the consent form and thought it had medicolegal implications. In contrast those who had a structured interview felt less obliged to sign the consent form and more involved in the decision to operate.

The object of this study was to compare the effect on the hearing of the insertion of a grommet, with or without adenoidectomy, against a non–surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion.

Seventy–eight children (44 boys, 34 girls, mean age 5.8 years) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment (pure tone average air conduction thresholds over 0.5, 1 and 2 kHz of ≥25 dB HL) over a three month period were admitted to a randomized, controlled trial. Each child was randomized to have or not to have an adenoidectomy. The ears in each child were then randomly allocated to have a grommet (tympanostomy tube) inserted. The children's hearing status was reviewed six and 12 months post–operatively. During follow–up, should a child redevelop a persistent bilateral hearing impairment (as defined above) for three months they were managed with a hearing aid. Thus no child had repeat insertion of a grommet.

Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post–operatively but not at 12 months when it was no different from natural resolution.

If resolution of the otitis media with effusion is the outcome measure, then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls. Even in boys it only resolves about 60 per cent of effusions. However, when combined with a grommet (one insertion) adenoidectomy gives no greater resolution (89 per cent compared with 86 per cent).

If improvement in hearing is the outcome measure, the overall results are similar. Adenoidectomy alone has an effect but if a grommet is inserted, adenoidectomy in addition does not improve the overall effect. However, these findings are not the case when analysed regarding the sex of the subject mainly because of the higher natural resolution rate in girls. In them, at six months surgery of any type or combination has no effect whereas in boys there is an additive effect of adenoidectomy on grommet insertion. Hopefully further studies can be conducted in larger numbers to investigate the differing effect in boys and girls suggested in this study.