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The case histories of 4 patients are presented, who developed an invasive squamous cell carcinoma from pre-existing multiple laryngeal papillomatosis (two juvenile-onset and two adult-onset) during a long latency period. A series of 14 routinely processed, paraffin-embedded biopsies obtained from these patients (including both benign papillomas and carcinomas) were analysed using in situ DNA-hybridization technique with 35S-labelled Human papillomavirus (HPV) DNA probes of HPV types 6, 11, 16, 18 and 30. The lesions were also assessed by indirect immunoperoxidase (IP-PAP) technique to demonstrate the expression of HPV structural proteins. On light microscopy, morphology was consistent with HPV infection in all 14 biopsies. HPV antigen expression could not be demonstrated in any of the papillomas or carcinomas, however. HPV 11 DNA was present in high copy numbers in both the benign and malignant lesions of 2 patients, both presenting with the juvenile-onset disease. The present findings provide support for the role of HPV as an etiological agent in laryngeal squamous cell carcinoma, most probably acting synergistically with chemical or physical carcinogens (one patient received irradiation and 2 others were smokers). It seems clear that an infection by the 'low risk' HPV types 6 and 11 by no means excludes the possibility of developing a laryngeal malignancy, so far ascribed to the 'high risk' type HPV 16 only.

The decrease in loudness level of a pure tone was used as a criterion of suprathreshold auditory adaptation. The measuring technique is based on continuous binaural balancing of a steady adapting tone with an interrupted comparison tone of equal frequency, the pulse and pulse intervals being of 200 msec duration. This comparison tone eliminates the source of error caused by adaptation in the control ear, as was common in earlier test methods. Three adaptation types were found in normally hearing adult persons, for which values at 20-80 dB SL for frequencies between 250 and 6000 Hz are given. In children the test generally failed to reveal adaptation. In conductive deafness, adaptation was equal to that found in normal adult group. Very pronounced values were found in retrocochlear deafness. In primary hair cell lesions adaptation was slighter than in normal-hearing ears.

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.

199 children with blunt head injury were examined. Eighteen fractures of the temporal bone were found, two of which were transverse. In both cases the damaged ear remained completely deaf. Of the 16 longitudinal fracture patients, one was left with a persistent 27 dB conductive hearing loss. In another, surgery revealed fractures of the stapedial crura. Persistent sensorineural hearing loss (≥30 dB) at high frequencies (4 to 8 kHz) was observed in 7 of patients. The results of the audiological tests led to the conclusion that sensorineural hearing loss in association with head injury is generally located in the inner ear. The auditory sequelae after head injury in children were found to be similar to those reported earlier in adults. Key words: hearing loss; head injuries

Fluoride level artificially elevated to 0.95-0.99 µg/g in drinking water has within 20 years caused a highly significant increase in the fluoride content of bone compared with the values found in residents of a low-fluoride area. This fact, however, does not seem to have any effect on the occurrence of otosclerosis or on the age at which the disease manifests itself. However, drinking water flu-oridation seemed to have a slightly beneficial influence on the bone and air conduction thresholds of the otosclerotic patients, i.e. on the severity of the disease.

Results are reported of the effect ov various surgical methods on vertigo in Meniere's disease. Minor procedures like sacculotomy or application of NaCl crystals in the round window may effect a cure, but often results in deaf ears. Vestibular nerve section seems to offer the best relief of vertigo, while generally still preserving residual hearing.

The decline in loudness of a pure tone was used as a criterion of perstimulatory suprathreshold auditory adaptation. The testing technique consisted of continuous binaural balancing of a steady adapting stimulus with an interrupted comparison tone of equal frequency, the pulse and pulse intervals being of 200 msec duration. The measurements were carried out in the majority of cases at 60 dB sensation level for frequencies 2 000 to 4 000 Hz. In normal-hearing test subjects younger than 15 years, as compared with adults, adaptation was of a different character. It could be demonstrated only in few cases, which were almost without exception among the oldest in their group. The amount of adaptation in the group of 15-18-year-old subjects did not differ statistically from that of the adult persons, even though the adaptation was slight in 25 % of the cases. The lacking or slight adaptation was noticeable also in all types of hearing disorders in the young patients.

Perstimulatory suprathreshold adaptation was studied in 243 patients with various types of sensorineural hearing loss. The technique was based on the continuous binaural loudness balance, the comparison tone consisting of pulses of 200 msec and intervals of the same length. Measurements were carried out at 20, 40 or 60 dB SL for frequencies 1000-4000 Hz. In primary hair cell lesions adaptation was slighter than in normally hearing ears, and it tended to decrease with increasing threshold loss. Very pronounced adaptation values were found in retrocochlear deafness. In central nervous lesions they were normal.ZUSAMMENFASSUNGPerstimulatorische überschwellige Adaptation wurde an 243 Patienten mit verschiedener Schallempfindungsschwerhörigkeit geprüft. Die Messtechnik gründete sich auf binauralen, dauernden Lautstärkevergleich. Der Prüfton bestand aus 200 msec langen Impulsen und ebenso langen Intervallen. Stimulusintensität war 20, 40 oder 60 dB über dem Schwellenwert, für die Frequenzen von 1000-4000 Hz. Bei Haarzellenbeschädigungen war die Adaptation geringer als in den normal-hörenden Ohren. Sehr grosse Adaptationswerte wurden bei retrocochleären Störungen gemessen. Bei zentraler Schwerhörigkeit war die Adaptation normal.

Results of otosclerosis surgery using the stapes footplate removal with various types of reconstruction are reported in 456 ears (360 patients). Primary success was obtained in around 95 % while 83 % retained their improvement over the years. The posterior crus on fascia has become the preferred method because of its stability and relative lack of inner ear complications. Inner ear damage is mostly due to perilymph fistulae, which should be promptly recognized and repaired, since revision after the ear has become deaf does not restore hearing. Some late inner ear losses may be due to reactions to foreign material introduced with the graft. Bilateral operations should not be done if the first operation was difficult or caused vertigo for several days.

A Grason - Stadler E800 Békésy audiometer was used for threshold measurements with sweep - frequency technique starting from the low tones (forward) and then from the high frequencies (reverse). The tracings were superimposed for both interrupted and continuous tones in normal - hearing subjects and in cochlear deafness. In some cases, most frequently in retro - cochlear lesions, the reverse tracing was poorer than the forward curve for continuous tones in the middle - and/or high - frequency regions. This behaviour was associated with pronounced threshold tone decay and, almost without any exceptions, with negative or incomplete recruitment.

Sixty presbyacutic ears (30 subjects) were studied with forward and reverse sweep frequency technique between 125–8000 Hz using a Grason-Stadler Model E 800 audiometer. The sweeps with continuous tones gave slightly better threshold values in forward than in reverse direction at middle and high frequencies, the situation being opposite at low frequencies. The starting direction (125 or 8000 Hz) did not affect the results. For interrupted stimuli the thresholds were overlapping. None of the ears showed abnormal fatigability and the amplitude of threshold tracings suggested the absence of recruitment. Thus, degenerative changes in the end organ or in the ganglion cells due to presbyacusis do not cause abnormal separation of forward and reverse sweep frequency tracings.

Perstimulatory suprathreshold adaptation was studied on 30 otosclerotic and 40 chronic ears, using the decrease in loudness level of a pure tone as a criterion. The comparison tone was interrupted, the pulses and free intervals were each of 200 msec duration. Measurements were carried out at 60 dB sensation levels for frequencies 1000–4000 Hz. The prestimulatory balance levels were higher than in normal-hearing ears. Adaptation was of equal amount as in normal ears and could be classified into three different types. In conductively deaf children adaptation could be demonstrated only exceptionally.

Mediastinoscopy was made in 338 patients with lung cancer and biopsies were taken from paratracheal, parabronchial and carinal lymph ncdes. Positive biopsies were obtained in 159 cases (47%). In 168 right lung tumors, metastases were found ip-silaterally in 49% and contralaterally in 20%. Of 170 left lung tumors, 45% showed metastases ip-silaterally and 25% also on the contralateral side. Contralateral metastases from the right upper lobe were rare (2%). Histologically, epidermoid carcincma showed the lowest number of metastases (34%) while the microcellular anaplastic type had metastases in 81%. When the mediastinal lymph nodes become involved, curative surgery is very rarely useful and radio- or chemotherapy should be considered.

Four cases of carotid body tumor are reported. The value of carotid angiography is stressed, the collection of dye in the tumor being diagnostic. Occlusion of the carotid circulation with clamps during final dissection of the bulb area is recommended for added safety. If occlusion takes more than 10 min, use of an internal shunt is preferable. Preoperative planning of the steps to be taken to avoid any possible complications eliminates the hazards otherwise associated with removal of these tumors.

Five clinically typical cases of fibrous dysplasia are analysed. Histopathologic and histochemical study revealed great variability from one lesion to another, and in one and the same specimen. One case showed the histologic features of fibrous dysplasia, ossifying fibroma and giant cementoma. The microscopic appearance of fibrous dysplasia is affected by the age of the process and of the patient. Definitive pathologic differentiation between the benign fibro-osseus lesions of the jaw bones can be made on the basis of microscopic characteristics together with clinical findings. The best way of treating fibrous dysplasia is by conservative surgery. In one case postoperative regrowth was successfully controlled with ACTH and oxyphenbutazone.

Using the technique of manual adaptation test, recordings of perstimulatory changes at threshold were made during a 3-min. stimulation period on 300 patients, suffering mainly of perception deafness. Results are reported of the magnitude of the perstimulatory threshold shift at various frequencies, of the relation of this shift to recruitment phenomenon, and of the frequency of cases with extreme tone decay in various diagnostic groups.

The decrease in loudness level of a pure tone was used as a criterion of suprathreshold auditory adaptation. The measuring technique is based on continuous binaural balancing of a steady adapting tone with an interrupted comparison tone of equal frequency, the pulse and pulse intervals being of 200 msec duration. This comparison tone eliminates the source of error caused by adaptation in the control ear, as was common in earlier test methods. Three adaptation types were found in normally hearing adult persons, for which values at 20-80 dB SL for frequencies between 250 and 6000 Hz are given. In children the test generally failed to reveal adaptation. In conductive deafness, adaptation was equal to that found in normal adult group. Very pronounced values were found in retrocochlear deafness. In primary hair cell lesions adaptation was slighter than in normal-hearing ears.

Eustachian - tube patency was measured with Bortnick's technique in 120 chronic ears. The positive test correlated reasonably well with good postoperative results in the normal tympanum and in cases of mild tympanal pathology. In general, the otomicroscopic result as found to provide a more reliable basis for estimation of the prognosis of tympanoplasty. If the formation of adhesions during the primary healing period is prevented, the function of the Eustachian tube can postoperatively be restored, making an aerated tympanum possible.

During the 2-year period of 1964-1965, 303 chronic ears were operated at the Oulu Clinic. In 70 cases a myringoplasty or tympanoplasty was made without mastoid bone work, and in 233 cases the radical bone removal was included. For repair of the drum and part of the meatus, temporal muscle fascia was used exclusively, and the cavity was occluded with the musculoperiosteal pedicle flap as advocated earlier. Certain important phases of the tympanic repair are elaborated, and results in various clinical subgroups presented.