We have identified immune factors within the tumour microenvironment, which are critically related to prognosis and also those, which require further work to elucidate their full relevance. Furthermore it is clear that if immunotherapy is to be introduced as an adjunct in the treatment of head and neck cancers, different immunological parameters will need to be selected for each distinct subsite.

Acute otitis media (AOM) is a common problem facing general practitioners, paediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of AOM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including 'AOM', 'epidemiology' and 'management'. Relevant articles were identified and examined for content. What is the take-home message? AOM is a very common problem affecting the majority of children at least once and places a large burden on health care systems throughout the world. Although symptomatic relief is often enough for most children, more severe and protracted cases require treatment with antibiotics, especially in younger children.

Otitis media with effusion (OME) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the etiopathogenesis, epidemiology, presentation, natural history and management of OME. The literature was reviewed by using the PubMed search engine and entering a combination of terms including 'otitis media with effusion', 'epidemiology' and 'management'. Relevant articles were identified and examined for content. What is the take home message? While OME is a very common entity in the pediatric population, the majority of cases will resolve spontaneously. Surgery in the form of grommet insertion, with or without adenoidectomy is the most effective treatment in persistent symptomatic cases.

Chronic otitis media (COM) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of COM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including "COM", "diagnosis", "incidence", "complications" and "management". Relevant articles were identified and examined for content. What is the "take-home" message for the clinician? COM is a common problem with various sub-categories according to the disease state. It most commonly presents with painless otorrhoea and hearing loss. Treatment options vary according to the activity and type of disease encountered. COM carries significant patient morbidity.

SUMMARYPoor systemic absorption has limited the, efficacy of early oral acyclovir in herpes zoster ophthalmic us (HZO).Aqueous humour levels are substantially higher if the drug is administered topically to the eye. A multicentre open randomised study was performed to compare the ocular prophylactic effects of topical and oral acyclovir.Fifty-seven patients with HZO within 72 hours of the onset of rash received either topical acyclovir ointment or 800 mg oral acyclovir, both 5 times daily for 7 days, and were followed for 12 months. Patients receiving ointment were significantly more likely to have ocular complica tions (p<0.02) and anterior uveitis was significantly more frequent (p<0.01) and severe (p<0.0l). Corneal hypo aesthesia was significantly more frequently (p<0.05) and severe (p<0.02) at 1 month. From 2 weeks patients receiv ing ointment were more likely to have pain and at all times their pain was more severe, but these differences wer� not statistically significant. In spite of its apparently better penetration topical acyclovir appears to have no prophylactic value in the management of early HZO.Herpes zoster is the commonest disease of the nervous system. Prevalence increases with age and it has been esti mated that each individual has a 50% risk of being affected by age 85 years and a I % chance of being affected twice. 1 Of affected cases 10-17% are ophthalmic, and this is the second commonest site after thoracic dermatomes.1,3Ocular complications at some time after the onset of rash occur with a frequency of around 50% in herpes zoster Qphthalmicus (HZO), with activity persisting for 6 months or more in up to 28% of initially affected eyes.4 Incidence and severity of ocular complications are not related to age, sex or severity of rash, but involvement of the external division of the nasociliary nerve is signifi cantly associated with the development of ocular compli cations. Complications in HZO are varied,4-R with anterior uveitis being the commonest followed by varieties of kera- Eye (1994) 8, 688-691 © 1994 Royal College of Ophthalmologists titis. Onset of acute ocular complications ranges between 7 and 28 days. Up to 93% of patients with HZO experience acute pain.4 Chronic pain occurs in up to 34%,1,1,4,9,10 becoming more frequent with age and rising to 71 % in those aged 80 years and over.4Management of HZO remains controversial. Recent attention has centred on the role of antivirals and in par ticular acyclovir in management and prophylaxis. There is also a role for topical steroids but the precise relationship between these two therapeutic options remains unclear. 1 1, [ 1 Two studies have reported prophylactic effects in the eye of oral acyclovir in HZO provided it is commenced within 72 hours of the onset of rash.13.14 Results were somewhat conflicting, with one study show ing an early [ J and one a late effect. [4 A retrospective case control investigation failed to detect a significant thera peutic effect. [5 Double-masked placebo-controlled studies on the effect of acyclovir on pain ...