The Groningen and Provox tracheo-oesophageal valve voice prostheses have been used in post-laryngectomy patients extensively in Sheffield since 1986 and 1990, respectively. To the present time a total of over 40 patients have made use of these devices, two thirds of whom underwent insertion at the time of laryngectomy. Prostheses were replaced under local or general anaesthesia if they were leaking or if phonation became increasingly difficult. Our experience with over 200 valves including the Groningen High Resistance, Groningen Low Resistance and Provox prostheses in this patient group is presented. We believe that the primary insertion of a low resistance prosthesis, either the Provox or Groningen Low Resistance device, is the method of choice in speech rehabilitation following laryngectomy.

In 1993 a multidisciplinary neurotology clinic was established at the Toronto Hospital, University of Toronto, Where patients with symptoms of dizziness were assessed by both otolaryngologists and neurologists. The results from the first 400 patients seen in consultation are described. The disease pathologies identified in this patient population with dizziness showed some significant differences from other published series, which we believe reflects the specialized tertiary nature of referrals to this clinic. A model for the collaborative investigation of the dizzy patient is provided consistent with the current trend towards multidisciplinary approaches in medicine.

To investigate the impact of a waiting list initiative on an ENT surgical waiting list, we have evaluated the outcome of the Tayside ENT Waiting List Initiative. Four hundred and forty-five patients were offered dates to come in during the initiative. Of these, 280 underwent surgery and 16 indicated that their operations were no longer necessary. The maximum wait for routine operations falling within the criteria for inclusion in the initiative was 28 months prior to the initiative and 7 months afterwards. A waiting list initiative can be effective in reducing waiting times for routine surgery. However, it is tooearly to describe the Tayside initiative as an unqualified success, as it remains to be seen whether or not the waiting list will lengthen again now that it is over.

This study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rates associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 per cent of those in whom at least one tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.