This randomized placebo-controlled cross-over trial assessed the effectiveness of a mandibular advancement appliance (MAA) in managing obstructive sleep apnoea (OSA). Twenty-one adults, with confirmed OSA, were provided with a maxillary placebo appliance and a MAA for 4-6 weeks each, in a randomized order. Questionnaires at baseline and after each appliance assessed bed-partners' reports of snoring severity (loudness and number of nights per week), and patients' daytime sleepiness (Epworth Sleepiness Score, ESS). The Apnoea Hypopnoea Index (AHI) and Oxygen Desaturation Index (ODI) were measured at baseline and with each appliance during single night sleep studies. Seventy-nine per cent of subjects wore their MAA for at least 4 hours at night. Sixty-eight per cent of subjects wore their MAA for 6-7 nights per week. Excessive salivation was the most commonly reported complication. One subject was unable to tolerate the MAA and withdrew from the study. Among the remaining 20 subjects, the MAA produced significantly lower AHI and ODI values than the placebo. However, although the reported frequency and loudness of snoring and the ESS values were lower with the MAA than the placebo, these differences were not statistically significant. When wearing the MAA, 35 per cent of the OSA subjects had a reduction in the pre-treatment ODI to 10 or less, while 33 per cent had an AHI of 10 or less. The MAA was less effective in the subjects with the most severe OSA (pre-treatment ODI > 50 and/or pre-treatment AHI > 50).

The relationship between diabetes and senbsorineural hearing loss has been disputed. This study compares 44 insulin-dependent diabetics with 38 age and sex matched controls. All had pure tone and speech audiometry performed, with any diabetics showing sensorineural deafness undergoing stapedial reflecx decat tests. In 14 diabetics stapedial reflex tests showed no tone decay in any patient, but seven showed evidence of recruitment. Analysis of vaiance showed the diabetics to be significantly deafer than the control population.The hearing loss affected high frequencies in both sexes, but also low frequencies in the male. Speech discrimination scores showed no differences. Further analysis by sex showed the males to account for most of the differences. Analysys of the audiograms showered mostly a high tone loss. Finally duration of disbetes, insulin dosage and family history of diabtes were not found to have a significant effect on threshold.

Drooling is common in patients with neurological disability and a major factor affecting quality of life. Management of this problem is best carried out by a team approach using surgical and non-surgical methods. Submandibular duct relocation is a commonly performed procedure with low complication rate. This procedure has been carried out in 56 patients over the last 14 years at the Belfast City Hospital by the senior author. All the patients underwent physiotherapy for six months before they were selected for surgery. All the patients were over five years of age and most had severe neurological impairment. For the purposes of this study, all the patients were followed by a questionnaire regarding symptomatic improvement, parent satisfaction and complication rate. All case notes were also reviewed retrospectively. Parental satisfaction was high and drooling was significantly reduced in 49 cases. The main complication was ranula formation seen in five cases. The most significant area of parental concern was post-operative pain. It is important to counsel the parents regarding the post-operative pain relief as well as failure rate of the procedure. It can be concluded that this procedure is a safe and highly successful procedure, which significantly improves the quality of life.

Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.

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Intractable epistaxis associated with septal perforation is a difficult problem to treat, particularly if nose-picking appears to be associated. Two such cases are presented in which Young's procedure of nasal closure was used to prevent epistaxis. Although the procedure was fully successful in only one patient, we feel the procedure has a part to play in the management of such cases of epistaxis.