Twenty-five patients with thirty ears affected by tuberculosis of the middle ear cleft were diagnosed and treated at Groote Schuur Hospital, Cape Town, during the years 1972 to 1983. This series is a sequel to the series of 1967 to 1971 and reported by Sellars and Seid (1973). The classical disease presentation will be reviewed and compared to that found in our patients. The modern trends in diagnosis and management will be discussed. The emphasis is on early diagnosis and treatment in an eminently curable disease.

A patient suffering from malignant external otitis (MEO) underwent early blood pool scanning followed after 2 hours by 99m To MDP bone scanning, and serial Ga-67 citrate scintigraphies of the skull. The former two procedures served as a diagnostic tool to MEO. The latter was used for estimating the extent of the infective process, and for following-up the efficacy of treatment.

The complementary role of these three procedures in the diagnosis, and follow-up of MEO, with special emphasis on immediate blood pool scanning as part of the diagnostic procedure, is illustrated.

The object of this study was to investigate the anatomy, histology, and possible function of a conical structure found in the middle ear of the cat. This conical structure lies across the dorso-caudal compartment of the middle ear. It is directly related to the course of the chorda tympani nerve in the middle ear. Its base is attached by fibrous tissue to the dorso-caudal segment of the tympanic bone adjacent to the tympanic membrane. Its apex rests on the promontory just rostral to the round window niche. Histologically, it is cartilaginous tissue enveloped by a mudous membrane with no trace of bone. Portions of some conical cartilage specimens display extensive calcification. A previous hypothesis suggests that this structure conducts high frequency sounds directly from the tympanic membrane to the round window membrane. This seems unlikely because its length is shorter than the distance between the tympanic membrane and round window membrane. The conical cartilage may be a vestigial remnant of the second arch bar (Reichert's cartilage).

Abstract Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983. Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane.

Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S. pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent). S. pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50–75 per cent). Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM.

In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same nacteria in 43 out of 44 cases. (97.7 per cent), indicating the presence of bacterial infection through the auditory canal.

Antibiotics were selected according to an Expected Efficiacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor.

Twelve middle ears from human cadavers, prepared for total grafting and preserved in sialit (1:5000) for more than 10–12 months, were studied with the aid of a scanning microscope. Such investigations have not been reported before in the medical literature.

The observed de-epithelialization of most of the membrance and of the ossicles and the distortion of the joints in the transmission apparatus are considered to be results of the prolonged preservation in sialit. The mesenchymal structures are well preserved and this may indicated that, after grafting, revasuclarization occurs along the lumina of the ‘empty’ vessels.

Becuase of this finding it might be considered that the maximum duration of preservation in sialit should be no longer than 10–12 months.

Following a minimum observation time of 14 months, 74 patients having undergone surgical correction of prominent ears were re-examined. The applied surgical technique was modified from Stenström and Warrer utilizing the scoring technique and subcutaneous matters chrome catgut sutures for fixation. Satisfactory results were achieved in more than 95 percent of the patients. When assesed by both the patient and the surgeon. Only few complications were revealed

We have studied 47 children (58 ears) with external and middle-ear malformations. Tomography was useful and effective in the pre-operative evaluation of anatomical patterns. We have divided our cases into four groups and described the most characteristic tomographic findings in each. We also discuss problems concerning patients immobilization and X-ray protection.

Over the past one hundred years medical views on the cause of glue ear have frequently changed. The medical literature was reviewed to see if these changes reflected advances in the level of scientific support for different causes. This revealed that only a few of the many proposed causes command any scientific support. An explanation for the changing pattern of views on the aetiology of glue ear was therefore sought by considering secular changes in medical knowledge and belief in general. This suggested that the views held on the cause of glue ear at any given time are influenced and largely determined by the prevailing knowledge and beliefs of medicine as a whole. This phenomenon is not peculiar to glue ear—though conditions about which there is considerable uncertainty are probably more susceptible to such influences.

Fifty-seven patients between the ages of zero and 16 years, treated for nasal fractures during childhood by means of closed reduction, have been subjected to follow-up examination after development of the nose has ceased. These patients have been compared to a control group of 50 persons without any known nasal trauma. No difference was found between the two groups with regard to functional complaints, but deviations of the osseous and cartilaginous pyramid, humps and sáddle formations, as well as spine formations and deviations of the septum, were particularly prevalent in the fracture group. Crista formation and angulation were found to be equally frequent in both groups. The findings are discussed.

Metastatic tumours of the temporal bone seem to be more common than is recognized. Most of these tumours are microscopic and asymptomatic in nature. Microscopic examination of 22 temporal bones belonging to 13 cases of metastatic tumours is reported. The commonest site of involvement in the temporal bone was the petrous apex followed by the tegmen tympani, mastoid bone and internal auditory canal. Primary tumours were most commonly located in the breast. Other sites of primary tumours included the thyroid gland, brain, lungs, prostate and blood (leukaemia). Two cases had undetermined sites of origin. Full neurotologic evaluation is indicated in every case suspected of having a temporal bone metastasis. All three modalities (of surgery, radiotherapy and chemotherapy) are used in combination for the treatment of these tumours.

Human cochleae were fixed in glutaraldehyde, without the use of osmium. Crosslinks were seen between the stereocilia, similar to those we have previously reported for the guinea pig: first, stereocilia of the same row on each hair cell were joined by horizontally-running links; secondly, the shorter stereocilia had pointed tips, each giving rise to a single, vertically-pointing link, which ran upwards to join the adjacent taller stereocilium of the next row. We suggest that distortion of this link is involved in sensory transduction. The links were sparser than had been seen in the guinea pig which may be a reflection of the vulnerability of the links to nonoptimal fixation, and the greater difficulty in producing good fixation in human specimens.