Tinnitus is a common experience with up to one third of the adult population experiencing it at some time in their life. Less than 1% of the adult population have tinnitus of sufficient severity to affect their quality of life seriously (although up to 8% may seek medical advice about it). Much of the severity of tinnitus relates to the individuals' psychological response to the abnormal tinnitus signal. The prevalence of tinnitus increases in association with high frequency hearing loss. There is, unfortunately, no diagnostic test that either confirms the presence of tinnitus or its severity. Currently there is no satisfactory severity grading system. A five-point severity grading scheme is therefore proposed and the entry criteria detailed. The five severity points are: slight, mild, moderate, severe and catastrophic. Categorization as 'severe' or 'catastrophic' should be, by epidemiological definition, very rare. General guidance, theory and evidential support are contained within.

In an effort to establish factors responsible for our post laryngectomy fistulae we reviewed 357 patients who underwent total laryngectomy between 1965 and 1990, for laryngeal carcinoma. Pharyngocutaneous fistulae occurred in 84 cases (23 percent). There was no difference between the fistula group and the non-fistula group with regard to age, sex, general condition, or tumour differentiation. The only significant, positive association was with previous radical radiotherapy (10 fistulae out of 167 primary laryngectomies (4 percent) versus 74 fistulae out of 190 salvage laryngectomies (39 percent)). The median time to occurrence of a fistula was day seven in both groups. However, in the non-radiotherapy group the median duration of the fistula was 28 days; the majority healing spontaneously, with only one patient requiring surgical closure. There were no ‘hospital’ deaths. In the radiotherapy group the median duration of fistulae was 112 days with 30 patients requiring a total of 66 procedures to achieve closure of the fistula. There were six ‘hospital’ deaths in this group.We conclude that previous radical radiotherapy strongly predisposes towards the occurrence of a postlaryngectomy fistula. Fistulae in this group tend to be longer lasting and are more likely to require surgical repair.

A randomized prospective trial was conducted to compare the efficacy of laser cautery against sub-mucosal diathermy to the inferior turbinates in 29 patients with rhinitis. Laser diathermy was performed using an arthroscopic fitment to a CO2 laser. Subjective and objective measurement of airway obstruction were performed, using a linear analogue scale and a nasal peak inspiratory flow meter, before operation and at 3 days and 6 weeks afterwards. In both groups there was a similar and significant improvement in subjective scores at 6 weeks (SMD from 3.6 to 1.8, P less than 0.01; laser from 3.9 to 2.1, P less than 0.001), but only the laser group was significantly better at Day 3 (SMD from 3.6 to 3.5, n.s.; laser from 3.9 to 3.0, P less than 0.05). In addition, there was significantly more general subjective morbidity at Day 3 in the SMD group (P less than 0.01). The objective scores improved equally in both groups but were not significant. We conclude that laser cautery of the inferior turbinate is a superior alternative to SMD for the treatment of rhinitis.

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