In recent years, closed cavity intact wall tympanomastoidectomy or combined approached tympanoplasty—(CAT)—has been described and recommended by many. The pendulum now appears to be swinging back again to open cavity tympanomastoidectomy. Pertinent literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with the achievement of a dry safe ear while a concomitant but secondary objective is hearing retention and restoration utilizing tympanoplasty techniques. Over a three-and-a-half year period we have utilized a one-stage procedure which provides the desirable objectives of both open and closed cavity tympanomastoidectomy called intact bridge tympanomastoidectomy (I.B.M.). The salient features include: (1) good exposure, as in open cavity tympanomastoidectomy; (2) maintaining and widening the middle-ear space by bony bridge retention and facial buttress sculpturing, to enhance grafting and ossiculoplasty such as TORP or PORP, as in canal up tympanomastoidectomy; (3) enhancement of mastoid obliteration for large cavities, by blocking the aditus with bone pate or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques and results are presented and discussed. The results have been gratifying to date. In comparison to intact wall tympanomastoidectomy, this one-stage operation avoids the cost and discomfort of a second and sometimes third stage; surgery for recurrent pathology has been avoided and hearing results have been at least comparable if not improved.

A study comparing otoscopy with tympanometry was carried out in 1702 ears in seven- and ten-year-old children. Pneumatic otoscopy in 917 ears showed an 88 per cent agreement with tympanometry. The agreement was better in ears considered normal by the otoscopist than in ears that were considered abnormal. Furthermore, the accuracy of otoscopy was better in the older children than in the younger ones.

A procedure employing simple otoscopy in 785 ears gave an 83 per cent agreement, but in about 15 per cent of these ears the examiner felt unable to base his evaluation on certainty.

It was found that a middle-ear pressure of –100 mm. H2O correlated with recognizable pathology when pneumatic otoscopy was performed.

This paper presents a rare case of meningioma arising in the right maxillary sinus of a 23-year-old Tanzanian male. It appeared as a painless swelling of the right side of the face. The diagnosis was made after histologic examination of the specimen removed by lateral rhinotomy.