Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines. - IntroductionThe submucous resection operation (SMR), as we understand and perform it today, was first described by Freer (1902) and by Killian (1904). They both, independently, recommended visualization of septal cartilage and bone, while preserving the overlying mucosa. The mucosa was allowed to fall into median apposition after the framework that held it off-centre had been carefully removed. The principle of saving a dorsal cartilaginous strut was established to avoid collapse of the supratip (Freer, 1902), while Killian also preserved a caudal strut (1904).The septoplasty operation was introduced approximately half a century later (Cottle and Loring, 1946;Goldman, 1956;Cottle, 1960), and has been subsequently modified on numerous occasions. The sine qua non of all methods is the conservation and relocation of septal supporting tissues. Septoplasty has to a large extent replaced SMR as the routine technique without solving all the problems of this type of surgery. Several studies in the literature reveal that 25-35 per cent of patients do not achieve a satisfactory result (Sloth and K0lendorf, 1976;Peacock, 1981;Stoksted and Gutierrez, 1983; Dommerby etal., 1985). We have therefore examined retrospectively the results of five years of septum operations at our institution.

Auditory brainstem thresholds have been determined in 35 non-cooperative, anaesthetized children using a 'two-point audiogram' paradigm. The high-frequency point was found with a 2 kHz tone-burst without masking, and the low-frequency with a 0.5 kHz tone-burst together with 1 kHz high-pass noise masking. Great variability was found in the low-frequency thresholds, and only 3 of 18 ears with normal high-frequency thresholds had low-frequency thresholds below 70 dB nHL. It is concluded that the 0.5 kHz tone-burst with 1 kHz high-pass noise masking is not a reliable method for routine assessment of low-frequency auditory threshold at the brainstem level.

The reproducibility of bone-conduction pure-tone audiometry and speech recognition thresholds has been tested in groups of normal-hearing subjects. Each person was tested twice during the same day, and the test-retest difference was calculated. The reproducibility is presented as the standard deviation of this difference. Bone-conduction threshold measurements have a high degree of test-retest precision, whereas air-bone gaps show a large range of distribution in these normal-hearing subjects. This makes the interpretation of such gaps spurious when values are below 20-30 dB. Speech recognition threshold has the highest degree of test-retest precision of all audiometric tests, and this is probably due to the steep slope of the psychometric function at 50% intelligibility. A more detailed graphic presentation of the 50% point of intersection will bring the reproducibility down to less than 2.5 dB.

A comparison has been made of air conduction threshold changes up to 1 year after myringotomy, aspiration of middle ear fluid, and insertion of ventilation tubes in ten patients with bilateral and 12 with unilateral secretory otitis media (SOM). Pure tone air conduction thresholds have been analyzed in three frequency groups: low frequency (LF; 0.25 0.5, and 1 kHz), high frequency (HF; 2, 4, and 8 kHz), and extra-high frequency (EHF; 10, 12, 14 and 16 kHz). In the LF and HF ranges, significant improvement came during the first 24 hours after intubation, while in the EHF range, threshold lowering occurred gradually over the following 2 months. Possible explanations for these findings are discussed.

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