Doubt has been raised about the long-term suitability of ossicular implants in tympanoplasty. Twenty-three ossicular implants that had been in the middle ear for a mean duration of 9.6 years were examined histologically by light microscopy. Although there were only two specimens showing subtotal replacement of the dead ossicular implant by new bone, the structural integrity of all implants was maintained and there was no evidence of overt osteoclastic bone resorption. Therefore our findings support the concept of prolonged survival of ossicular implants in the middle ear and we do not see any good reason for abandoning their use in reconstructive tympanoplasty.

The terms ‘planned two-stage operations’, ‘planned second-look operations’, ‘previous surgery’, and ‘revision surgery’ are discussed on the basis of our series of 2,303 ears operated upon from January 1965 to December 1980. We have not performed any planned two-stage operations. All operations prior to the first operation in our department are denoted ‘previous surgery’. ‘Revision surgery’ denotes all reoperations performed either in this department or elsewhere during the observation period until the end of 1984, and the revision rate is analysed in patients with different pathological conditions. ‘Revision surgery’ was performed in 15.6 percent of 740 ears with cholesteatoma (in 13.9 percent once, in 1.6 percent twice, and in 0.1 percent three times), and ‘previous surgery’ in 3 percent.

Among 229 ears with chronic granulating otitis, revision surgery had been performed in 12.2 percent up to December 1982. By December 1984, this figure had risen to 16.1 percent. ‘Previous surgery’ had been performed in 18.3 percent. A total of 38.4 percent had at least two operations.

The revision rate in other conditions varied from 10 percent (sequelae to chronic otitis) to 34 percent (post-inflammatory acquired atresia). These rates are discussed and the functional results presented.

The fate of 32 Per-Lee ventilation tubes inserted by a single surgeon for secretory otitis media in children and adults is analysed over a 15-year period. There were no extrusions and 25 tubes were still functional at the time of the survey. The total ventilation time achieved by the 32 tubes was over 157 years. Seven tubes were removed on account of either obstruction or infection. Spontaneous healing of the tympanic membrane was uncertain following removal of the tube and a considerable degree of scarring was inevitable. Hearing improvement occurred while the tube was functioning and there were no cases of hearing deterioration. It is concluded that the Per-Lee tube is a suitable prosthesis for long-term middle-ear ventilation.

Eight different ear plug materials were tested, in 5 ears each, in artificial shallow underwater conditions for 30 minutes, in order to determine their efficacy in sealing the ear canals to avoid water-borne infections in ear canals and open middle ears. Most of the plugs tested would meet everyday requirements for protection, but the polymeric foam plugs, treated with petroleum jelly, and moldable plastic materials were most effective in protecting both the middle ear and the ear canal skin.

This report presents a case where an open safety pin passed through the Esophagus and where Nature herself finally solved the problem by closing the pin, which was afterwards carried in the faecal stream and discharged from the body without any harm to the patient.

The long-term results of 925 stapedectomies were analysed after a mean follow-up period of 15 years. Patients who had the operation before the age of 30 were analysed separately. The entire group deteriorated by an average of 0.91 dB/year at 500–2000 Hz, while the under-30 group deteriorated by 0.67 dB/year. There were but slight differences in the conductive component, considering frequencies and age. The perceptive loss'year was not far from that in a normal population.

Present methods of linear measurement in micro-surgical procedures in the middle ear are crude when judged in relation to the delicate structure and functioning of the normal ear.

Alternative methods of measurement employing the operating microscope are described. These depend on recording the travel of the microscope between two selected focal points and can be employed in both vertical and horizontal planes. Oblique distances can readily be calculated from the information provided. Minor alterations to existing microscopes would be required to ensure precise recording bv electronic or linear methods.

In 54 ears lacking the stapedial arch and the long process of the incus, ossiculoplasty was performed with a shaped auto-or homologous incus as columella. In 29 of the ears, the deep, slender part of the columella was coated with a silastic tube in order to prevent adhesions and dislocation. One year after the operation the functional results were similar in patients with silastic coating of the incus to those without. It is concluded that the less satisfactory results of tympanoplasty in such ears are primarily caused by factors outside the niche of the oval window. Possible ways of improving the results are discussed.

The levels of prostaglandian E2 (PGE2) were measured in aspirates of the effusion fluid from children suffering from secretory otitis media. The effects of naproxen 5 mg./kg. twice daily for eight weeks on the condition were studied in a placebocontrolled double-blind trial.

Nineteen middle-ear aspiraes from 13 children, six of whom had bilateral aspirations were examined. Detectable levels of PGE2 and those without.

In a separate trial of naproxen, 11 patients received active drug and 13 received placebo. Naproxen had no significant effect on otalgia or hearing loss compared to placedo.

These findings suggest that is it unlikely that non-steroidal anti-inflammatory drug will be of therapeutic benefit in secretory otitis media.