The areas of the nasopharynx and its contents have been measured on the lateral cephalometric radiographs of 41 normal children who had been examined at yearly intervals for a minimum of 12 years between the ages of three and 19. The means and standard deviations of the areas of the nasopharynx, the soft tissues and the airway have been calculated for each year from three to 11 and for alternate years to age 19. The size and shape of the soft tissues of individual children are shown to vary from year to year, and the anterior convexity changes to a concave shape with maturity. The soft tissues appear to grow more rapidly from three to five than does the nasopharynx, with a consequent decrease in size of the airway at this period. Subsequently the soft tissue area remains relatively constant whilst the nasopharynx increases in size so that the airway progressively enlarges. There is a significant difference between the sexes in nasopharyngeal area from 13 onwards (p less than 0.005).

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic.There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes.A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

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The treatment of allergic rhinitis has been revolutionized by the introduction of topical nasal steroids, which are one of the commonest prescriptions from otolaryngology departments. With so many different sprays available on the market, the literature was reviewed for the efficacy, side-effect profile and relative cost of each product and the following conclusions made: (1) A meta-analysis of randomized controlled trials comparing the efficacy of intranasal corticosteroids and oral antihistamines in the treatment of allergic rhinitis showed a clear benefit in favour of intranasal steroids in relieving nasal symptoms. (2) There is no clear evidence to support the suggestion that one steroid spray is more effective than another in the treatment of seasonal or perennial allergic rhinitis. (3) All the sprays have a similar side-effect profile; the commonest being epistaxis with a reported incidence between 17 and 23 per cent. In all the clinical trials, the placebo spray had an appreciable rate of epistaxis of between 10 to 15 per cent. (4) Fluticasone causes a reduction in endogenous cortisol secretion but no significant adrenal suppression was seen with triamcinolone, beclomethasone, budesonide or mometasone. (5) There is little evidence that skeletal growth is restricted by the administration of topical nasal steroid sprays. (6) There is considerable variation in the daily cost of each spray. Beclomethasone, dexamethasone and budesonide are significantly cheaper than fluticasone, mometasone or triamcinolone.

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Data on the prevalence of otitis media with effusion (OME) as shown by serial tympanometry is presented for young children during the first 5 years of life. The children were participants in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had no effect, there was a decrease in prevalence of OME with increasing age. There was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral OME were significantly more prevalent in the winter than in the summer months (36.6% in February in children aged 8 months compared with 16% at 61 months and 16.4% in August in children aged 8 months compared with 3.1% at 61 months). The results form an important background against which to assess both the results of screening and also the indications for surgical treatment.

Forty-six children were independently assessed with respect to size of adenoids and other clinical features by 3 observers of differing experience. Similar assessment was made of adenoid area and post-nasal-space airway from lateral cephalometric X-rays. The inter-observer agreement for these findings has been calculated. Absolute agreement between observers for the assessments is poor and in some instances this is related to clinical experience. In relative terms the agreement is more satisfactory. A nasal obstruction score due to adenoid enlargement has been derived from assessment of mouth breathing and speech hyponasality and this is shown to correlate with the nasopharyngeal radiology score derived from visual assessment of the radiological adenoid area and post-nasal-space airway. The radiology score correlates well with measurements of the nasopharyngeal area made by planimetry. Both the radiology score and the nasal obstruction score correlate with the volume of adenoid tissue removed at adenoidectomy. This study provides the basis for a scoring system for the clinical and radiological assessment of adenoids in order to detect preoperatively those children most likely to benefit from adenoidectomy.