A randomized comparison of the usual surgical removal of nasal polyps versus systemic steroid treatment was performed in 53 patients. In all, continuous topical steroid treatment was given during the one year period of observation. In both groups the initial treatment resulted in a continuous increase in mean nasal expiratory peak flow as well as in the sense of smell; these two parameters showed a temporary statistically significant difference in favour of the medically treated group. In general though, the results in the two treatment groups were alike. Therefore medical treatment is recommended for routine use. Surgical removal should be reserved for those few cases in which the presence of residual or recurrent polyps justifies the inherent risks and discomfort for the patient.

An epidemiological study of negative middle ear pressure in children made it possible to test its relationship to conductive hearing loss. About 350 children were subjected to a screening procedure recording audiogram and middle ear pressure five times during a 12-month period. Those children who failed to perceive just one tone or who had a middle ear pressure equal to or worse than -150 mmH2O in one or both ears were referred to the Hearing Clinic for conventional audiometry and middle ear pressure measurement each month. By computing the weighted average of the regressions for each child, a straight linear relationship was found between negative pressure and conductive hearing loss. In addition, a frequency dependence was found, the hearing loss being maximal at about 500 Hz. In general, the study shows that tympanometry is of limited value in predicting hearing loss in a child. The threshold for pathology of about -150 mmH2O, being a predisposing factor in secretory otitis media, corresponds to the upper confidence limit of the normal range of hearing loss found in this series. There is no distinct value of negative pressure that clearly distinguishes between normal and pathological condition, but it is concluded that a middle ear pressure worse than -150 mmH2O should be considered a probable hearing handicap.

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Systemic steroids may remove symptoms from nasal polyps in most patients, while surgery only is necessary in a few resistant cases. However. topical medication is preferable. Sprays may prevent recurrencies, but they seldom suffice for removing polyps. The aim of the present study was to document clinical efficacy of steroid nose drops. In 24 patients with nasal polyps documented by mini biopsy, aqueous budesonide (Rhinocort Aqua. Draco. Sweden) was applied as nose drops. Every second day 0.25 ml was instilled in each nostril with the head down and forward. Conventional spraying was done twice daily. The clinical condition. nasal expiratory peakjlow, and sense (?(smell was monitored for at least two months. Thefrequency (?( applying drops was decreased if smell returned or polyps disappeared while spraying continued. Afew patients were not able to comply, and afew noticed insignificant nasal bleeding. In most cases the patients were satisfied after two or three months of treatment. It is concluded that in many patients nasal polyps can be managed by budesonide nose drops. However, the results of the present pilot study should be confirmed by controlled trials before routine clinical use is justified.