Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

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Glacial acetic acid, dexamethasone and neomycin sulphate is significantly more effective in treating otitis externa when compared with glacial acetic acid. This effect failed to be significant in the infected mastoid cavities group. We therefore recommend that in conjunction with aural toilet, antibiotic/steroid combination is more effective than an antibacterial agent for otitis externa. Larger numbers of infected mastoid cavities are required to be studied.

Health Services Research and Development EVELYN FLOOK FEDERAL GRANTS are intended to ex-pand research activities throughout the country, and to encourage investigators and institutions to undertake research in relatively neglected scientific areas. The need for Federal support of research aimed at better understanding of the problems inherent in hospital administration and of demonstrations designed to illustrate more effective methods of operation was recognized in the 1950 amendment to the original Hill-Burton legislation on hospital construction.The 1950 amendment authorized -the "conduct of research, experiments, and demonstrations relating to the effective development and utilization of services, facilities and resources of hospitals or other medical facilities . . ., icluding projects for the construction of experimental or demenstration hospitals or other medical facilities and projects for acquisition of experimental or demonstration equipment for use in connection with hospitals or other medical facilities."The 1950 amendment authorized an appropriation of $1.2 million annually, but no funds were made available until 1956. Consequently, in 1956 a program of grant and contract support for hospital research and demonstrations was

BACKGROUND: Acid reflux into the oesophagus, larynx, pharynx or nasopharynx has been suggested as a causal factor in chronic rhino-sinusitis (CRS), which can then be refractory to nasal treatments. The aim of this review was to conclude on the strength of the link between GORD, LPR, nasopharyngeal reflux, nasal symptoms and CRS. METHOD: Medline and Embase search. RESULTS: Nineteen papers describing varying studies on CRS, GORD, LPR and PPI therapy were found. Four adult case-controlled studies showed more acid reflux events/symptoms in refractory CRS patients. Paediatric cohort studies showed more reflux events in rhinosinusitis patients than the general paediatric population, but they are not conclusive. Many papers do not use robust CRS diagnostic criteria for inclusion into studies and take no confounding factors into consideration. CONCLUSION: The evidence of a link is poor with no good randomised controlled trials available. The few adult studies that show any link between acid reflux and nasal symptoms are small case-controlled studies with moderate levels of potential bias. There is not enough evidence to consider anti-reflux therapy for adult refractory CRS and there is no evidence that acid reflux is a significant causal factor in CRS.