Pope John Paul II made another brief appearance at the window of his Rome studio today as he struggled once more to bless thousands of pilgrims in St Peter's Square.

Alert but visibly ailing, the pontiff raised his hand in blessing and made the sign of the cross in silence. Although an aide proffered a microphone, the Pope's words to his weekly Wednesday audience were not clear. It was a Vatican official who read out greetings and prayers.

Many of those gathered on the square were clearly distressed, their hands clasped in prayer, as the Pope withdrew to his room after just under five minutes.

Today's appearance came amid reports that the pontiff - who turns 85 in May - could have to return to hospital for a third time in two months next week for an operation to insert a tube directly into his stomach so that he can be fed without having to swallow.

Corriere della Sera said that the Pope, who underwent a tracheotomy to help his breathing on February 24, was having serious difficulties swallowing as a result.

On Tuesday, the Rome daily La Repubblica quoted a neurologist, Stefano Ruggieri, saying that he may never be able to speak again. The Pope has cancelled all official engagements since he was discharged from hospital on March 13, although he made a brief and obviously painful effort to bless tens of thousands in St Peter's Square on Easter Sunday.

He has now been told to take absolute rest and is being kept in isolation from his Polish secretary, who is suffering with a cold.

Richard Owen, The Times's Rome Correspondent, was among the thousands gathered to witness the Pope's appearance today. He said: "Although he appeared today for his Wednesday audience he tried to speak, and again failed.

"There were several thousand people in the square, and they were clearly moved and distressed to see the Pope in this condition. However, there is a sense that people are coming to accept it.

"Many Vatican commentators in Italy are saying that we are now reduced to a Pope of gesture and symbolism, it's considered enough that he appears at all.

"The Vatican has said that before his appearance on Easter Sunday he had been practising to speak for at least a week. The official version of events is that when the moment came he was overcome with emotion. This is regarded with some cynicism, as this is not a man who has ever before had any difficulties with momentous events.

"It all makes one wonder what detailed instructions the head of the world's one billion Catholics is able to give to the church."

Nicola Cerbino, a spokesman at Polyclinic Gemelli hospital, said there was no immediate plan to hospitalise the Pope.

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