Laryngeal tuberculosis is now an uncommon disease in the United Kingdom. A series of ten cases is reported. In contrast to the pre-chemotherapy era, when the disease was associated with advanced cavitated pulmonary tuberculosis and was highly infectious, it now presents in a manner similar to laryngeal carcinoma except that painful dysphagia is a prominent symptom. All such patients should have a chest X-ray carried out as part of their initial investigation. Sputum is almost always positive for tubercle bacilli on direct films. Direct laryngoscopy and biopsy are necessary if a carcinoma is suspected.

The change of pattern of the disease may be due to the fact that the larynx now usually becomes involved by haematogenous spread rather than by direct spread along the airways. Laryngeal tuberculosis is now no more infectious than pulmonary tuberculosis, and responds well to antituberculous chemotherapy. Symptoms resolve completely within three weeks if corticosteroids are given in combination.

Perhaps our greatest difficulty in dealing with tinnitus is that our understanding of how sound energy is transformed into neural impulses is still rather theoretical. The transduction process of the hair-cell receptor is still not entirely understood. Nevertheless, Davis’ (1961, 1965) principles of sensory action and his model of the hair-cell transduction process (1965) have provided a useful framework for our thinking and have helped to guide investigations into the sensory physiology of hearing. I would like to review some of these principles in a vein similar to that of Tonndorf (1975). In so doing, I can reveal the strengths and weaknesses of our knowledge of how the ‘ear’ works.

Figure 1 illustrates some of the sailient features of sensory systems in general. Several electrical events are elicited upon stimulation: a receptor potential, a generator potential, and spike-action potentials. The relation of the receptor and generator potentials to the stimulus waveform and to one another depends upon the specific method of coupling the stimulus energy to the receptor, and the characteristics of the connection between the receptor and the sensory neuron.

A 54-year-old man presented with candida tropicalis meningitis after exploration of the mastoid. He responded well to the combined intravenous administration of amphotericin B and 5 fluorocytosine. But 5 fluorocytosine had to be withdrawn when the candida proved to be resistant to this antifungal agent. However, the patient made an uneventful recovery. This seems to be the first report of a candida tropicalis meningitis in an otherwise healthy adult patient in this country.

Infection of the meninges with candida remains rare (Black, 1970). Most of them are caused by candida albicans in patients with some other underlying conditions or those on prolonged antibiotic, corticosteroid, cytotoxic, immunosuppresive therapies. The purpose of this brief communication is to draw attention to its occurrence in a healthy patient following exploration of the mastoid for chronic suppurative middle-ear disease.

Mucocoeles, mucopyocoeles and empyemas of the sphenoid sinus are rare, but potentially dangerous. Their occurrence is accompanied by a multitude of clinical symptoms and signs, which confuse the diagnosis and may lead to its mismanagement. The treatment of this condition is surgical and in its early states essentially simple.

At Groote Schuur Hospital over a 6-year period (1972–1977) 6 patients with mucocoeles, mucopyocoeles or abscesses of the sphenoid sinuses have been seen. Their clinical presentation, radiological findings and surgical treatment are described and discussed. Correctly managed this condition should completely resolve; however, there is a mortality associated with delay or misdiagnosis.

The differential diagnoses and the duration of symptoms are presented for a group of 288 patients encountered over a ten-year period with a mass in the region of the neck behind and below the angle of the mandible. While infections constituted the largest aetiological group (48·3 per cent), 109 cases (37·9 per cent) had some form of neoplasia, with malignancy being found in 48 (16·6 per cent). The duration of symptoms varied widely, only the acute infections having an acceptably short delay prior to hospital admission. The mean symptom duration for all the neoplastic cases was in excess of five months.

The patient with a lump in the neck is a frequently encountered problem in ear, nose and throat practice. An important precept, which has long been recognized in the literature, is that any persistent asymmetrical mass in the neck of an adult must be regarded as malignant until definite proof to the contrary is obtained (Martin and Romieu, 1952; Slaughter et al., 1956; Skolnik et al., 1965; Shaw, 1976). Differential diagnostic possibilities in all age groups are however numerous, and pre-operative conclusions must often be revised following histopathological examination. A simple and rational approach, which is frequently of considerable value in the clinical assessment of these patients, is a combination of topographical and temporal classifications.

In 1960, Skandalakis et al. proposed a rule-of-7, in which the average duration of symptoms for cervical masses caused by infections was 7 days; for neoplasms, 7 months; while an interval of 7 years was characteristic of developmental anomalies. The topographical approach involves subdividing the neck into anatomical regions. The most posterior area, covered by the trapezius muscle is, in this context, of minimal clinical interest, since the overwhelming majority of neck masses lies anterior to this muscle. The clinically important part of the neck is subdivided into the anterior and posterior triangles by the sternocleidomastoid muscle. The posterior triangle is much less frequently the site of a neck mass, although malignancy is relatively more common in this region (Moussatos and Baffes, 1963). The anterior triangle is further subdivided by the digastric and omohyoid muscles into four smaller triangles, readily recognizable in the living neck, since both muscles are attached to the hyoid bone which can be palpated in the vast majority of cases.

The thyroid and submandibular glands are the most frequent source of neck masses in the inferior carotid, or muscular, and the digastric triangles respectively, and involvement of these organs can usually be readily recognized in the clinic (Beahrs, 1955; Slaughter et al., 1956; Skandalakis et al., 1960). The small submental triangle contains few structures of importance, and the majority of swellings in this region are either thyroglossal cysts or enlarged lymph nodes.

The situation is radically different in the carotid triangle, the region of the neck posterior and inferior to the angle of the mandible, where a wide variety of anatomical structures is congregated, and the differential diagnostic possibilities are consequently greater. The present study is a review of swellings in the neck confined to this area.

At Groote Schuur Hospital, Cape Town, over a 5-year period (1974 to 1978) 15 patients with squamous cell carcinoma of the larynx or hypopharynx have had planned 2,000 Rad Telecobalt therapy followed by supraglottic horizontal laryngectomy. Five patients following surgery had a further 3,600–4,000 Rad Telecobalt therapy.

The peri-operative complications, in addition to those of whole organ resection, included debilitating laryngeal incompetence in three patients, two of whom underwent total laryngectomy. All 15 patients have remained free of recurrent disease for 2 years and 10 have been free for 3 or more years. One patient dies 4 years after surgery from a primary bronchial carcinoma.