New Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented.The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children.The raw data from the 1978 study were reviewed. Of 134 children aged 4–13,12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children.The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occsaions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.

A survey of hearing amongst a population of Maori schoolchildren in the eastern North Island of New Zealand has demonstrated a high prevalence of hearing impairment. Out of 194 children undergoing audiometry an impairment of 20 dB or greater at 0.5, 1.2 and 4 kHz was found in the worse hearing ear in 29% and in the better hearing ear in 12%. Comparison with a similar survey done in the same valley in 1977 revealed an apparent reduction in the prevalence of hearing loss and the prevalence of otitis media. This improvement appears to be due to a reduced prevalence of otitis media. An unexpected finding was that at least 2% of the children had a bilateral sensorineural hearing impairment.

Middle-ear tumours are not uncommonly mistaken for mastoiditis on presentation. We report a case of cerebellopontine angle non-Hodgkin's B-cell lymphoma originally presenting as a middle-ear inflammatory process. In mastoiditis not resolving with conventional treatment it is important to look for an underlying cause.

Habitual, loud snoring is common in the adult population, and may be the only symptom of the more serious Obstructive Sleep Apnoea syndrome. We report here our results of uvulo-palato-pharyngo-plasty (UPPP), with or without nasal surgery, for snoring. Quantitative grading of the severity of the snoring shows that all patients were cured of symptomatic snoring, but that snoring was not altogether abolished in all patients.

Severe hearing impairment (SHI) is an impairment of hearing in which the air conduction mean over 0.5–4 kHz in the better hearing ear lies between 70 and 90 dB. Masking of bone and air conduction thresholds is seldom possible with SHI, leading to difficulties in assessing the pure tone audiogram whenever there is a potential air bone gap in either ear.An audiological survey of 83 patients with severe hearing impairment was conducted. In 16 per cent of patients there was no possibility of a material air bone gap in either ear and no difficulty in interpreting the audiogram. In 23 (28 per cent), the audiogram was consistent with, but did not prove the presence of, an air bone gap in the poorer hearing ear. In 25 patients (30 per cent of 108) the better hearing ear could not be determined, and in 22 (27 per cent) a profound sensorineural impairment in the poorer hearing ear could not be excluded. The implications of this for the otologist are discussed.