Mastoid obliteration in intact canal wall mastoidectomy.

Long-term results following intact canal wall mastoidectomy with cavity obliteration were compared with those following similar operations leaving the mastoid cavity as an 'air reservoir'. The incidence of adhesive eardrums was the same (12%) in both groups. In other respects, the obliteration technique gave slightly better results than the 'air reservoir' technique. Cavity obliteration is recommended in intact canal wall mastoidectomy.

Training of ear surgeons.

The results of surgery in eighty-two ears with chronic otitis media operated on by residents were compared with the results of surgery in 196 ears with chronic otitis operated on by senior surgeons. Despite all "difficult" and complicated chronic ears having been operated on by the faculty staff, the results in ears operated on by residents were in several respects poorer than in ears operated on by senior surgeons. Fortunately, no serious complication of surgery occurred in the ears operated on by residents. Methods for training residents in surgery are discussed.

Cholesteatoma surgery.

The results of surgery in 266 cholesteatomatous ears were analyzed. In most cases the canal down technique was used. The mean follow-up period was 6.0 years. The incidence of postoperative cholesteatoma was 6%, which is significantly lower than the incidence of residual and/or recurrent cholesteatoma following intact canal wall tympanoplasty reported by several other authors. The canal down technique seems to be superior to the canal up technique in the management of large cholesteatomas.

Surgery of chronic adhesive otitis media.

The results of tympanoplasty operations in 55 ears with chronic adhesive otitis media were analysed. In 34% of the ears, the tympanic cavity was found to be aerated on follow-up examination. Hearing improved significantly in only 13 ears (24%). There were severe complications of surgery in two ears (3.6%): one ear became totally deaf and an iatrogenic cholesteatoma developed in the other. Because of these poor results, tympanoplasty is not recommended in the treatment of chronic adhesive otitis media.

Failures in myringoplasty.

We analyzed those failures occurring in 417 myringoplasties. Forty-four drum re-perforations were found (10.6%), half of which occurred immediately after operation. Causes of these early failures included necrosis in the middle of the graft without infection (10 ears) and blunting of the anterior margins of the graft (7 ears). Infection was the most common cause of re-perforations in the later failures. Re-perforations also occurred more frequently when larger perforations were closed in contrast to repair of small ones. We found that other pre-operative factors ("dry" or "wet" ear, site of the perforation) or grafting technique ("underlay" or "overlay") did not affect the graft take-rate. Adhesive eardrums were found in 23 ears (5.5%). These were more common when ears were infected pre-operatively, when middle ear mucosa was removed during the primary operation, or when squamous epithelium was present on the tympanic mucosa. Lateralization of the grafted eardrum was found in two cases (0.5%), both of which had been operated on using the sandwich technique.

Results of stapes operations with preservation of the stapedius muscle tendon.

The material consisted of 195 operated otosclerotic ears. In 101 ears the stapedial tendon was left intact and in 94 ears it was divided. The follow-up period was approximately 8.0 years. The stapedius reflex was tested in 85 ears with intact tendon and in 25 with divided tendon. It was elicited in 50 of the former but in none of the latter. Both bone and air conduction thresholds were postoperatively poorer in ears with preserved tendon than in the ears with divided tendon. Revision surgery was performed in 19 ears, 13 of which had an intact stapedial tendon. The reason for reoperating was usually the fixation of the stapedial crus at the oval window margin. The crus may have shifted because of the pull exerted by the stapedial muscle. In spite of the better circulation to the stapes and the long process of the incus, and of possible protection against loud noises, we cannot, in the light of our experiences, recommend preservation of the stapedius muscle tendon.

Abscess tonsillectomy à tiède.

During recent years, primary tonsillectomy, tonsillectomy à chaud, has again become popular as the standard therapy for the peritonsillar abscess, whereas the traditional tonsillectomy à froid, made 4--6 weeks after the incision, has been partially eclipsed. It seems, however, that the intermediate form between these two, tonsillectomy à tiède, an abscess tonsillectomy made 3--4 days after the incision, would be highly practical in many cases, compared with the other two mentioned above. The tonsillectomy à chaud requires such a high state of readiness for anaesthesia, even during the emergency hours, that it is not practical in all otolaryngological departments. Tonsillectomy à tiède needs a longer hospitalization, yet requires fewer days off work than does the classical tonsillectomy à froid method. Furthermore, a significant proportion of the patients fail to present themselves for tonsillectomy at the agreed time and consequently get a recurrence of the disease later on. Tonsillectomy à tiède is almost as easy an operation as the normal tonsillectomy, both for the surgeon as for the patient. During the years 1976--77, 153 cases of peritonsillar abscess were seen. 105 cases were treated with the tonsillectomy à tiède method. The average duration of treatment was 6 1/2 days. The only complications were 6 cases of light secondary bleeding. A tonsillectomy à chaud was performed on 9 children in the age group 3--9 years.

Tracheopathia chondro-osteoplastica. A clinical study of thirty cases.

During the last 12 years, 30 cases of tracheopathia chondro-osteoplastica have been diagnosed at the Department of Otolaryngology of Kuopio University. Ten of these were accidentally revealed by bronchoscopy, 2 by autopsy, but 18 were revealed through a systematic examination. Ten of these 18 were preliminarily diagnosed by indirect laryngoscopy. The average age for women was 51 and for men 42, the youngest patient being 11 and the oldest 71 years of age. The characteristic symptoms were long-term recurrent cough, hoarseness and periodic expectoration. The sputum was frequently abundant and crusty, and sometimes contained streaks of blood. Shortness of breath was a common symptom, but there were often entirely asymptomatic periods. The disease begins with a persistent purulent tracheitis, which, probably owing to calciphylaxis, causes accumulation of calcium salts in the tracheal mucosa. Cartilage and bone later develop around these accumulations. In most of the cases of tracheopathia chondro-osteoplastica in the present series, the condition was associated with atrophic rhinitis or pharyngitis. As the nasal disease improves, some regression may occur, though hardly healing. Calcium and phosphorus metabolism was not disturbed, and no immunological aberrations were found in any of the patients in this series.