[A male with a pulsating ear drum]. / Een man met een kloppend trommelvlies.

A 28-year-old male presented with non-pulsatile tinnitus, rightsided hearing loss and an ipsilateral pulsating ear drum. A CT-scan revealed an aberrant internal carotid artery in the middle ear. This is an uncommon finding. Recognition of this birth analomy is important since ear manipulation or surgery can lead to life-threatening complications.

Implementation of the hyaluronic acid fat graft myringoplasty technique, pitfalls and lessons learned.

BACKGROUND: Myringoplasty is a common procedure in otorhinolaryngology. Many techniques with different complications and outcomes have been described, one of which is hyaluronic acid fat graft myringoplasty (HAFGM). This technique, as proposed by Saliba, uses fat tissue and hyaluronic acid discs. The technique is relatively fast with a high success rate and low complications. However, what outcomes can be expected when performed by other surgeons? In this paper, we report on the technique's success in our own hands. MATERIALS AND METHODS: Based on Saliba's protocol, we performed 86 HAFGMs by a transcanal approach between 2012 and August 2014. However, our 70% success rate was significantly different from Saliba's 92% (p value 2.8e - 05). We visited Saliba's clinic in order to identify critical differences between our approaches. We adapted the differences we found in our protocol and analysed another 50 HAFGMs performed afterwards, between October 2014 and December 2015. RESULTS: The success rate increased to 86-89%, this percentage is not different compared to Saliba's results (p value .25 and .54). CONCLUSION: HAFGM is a reproducible technique in the hands of other surgeons, but critical following of the surgical protocol is important.

[Recurrent otitis media and mastoiditis due to atypical mycobacteria]. / Recidiverende otitis media en mastoïditis door atypische mycobacteriën.

An eleven-year-old girl was operated on due to right-sided chronic otitis media with effusion. After three months, an impressive enlargement of the mucosal lining developed, for which thorough debridement of the middle ear and mastoid was performed. Histological examination revealed a granulomatous inflammation, with negative Ziehl-Neelsen staining. Standard bacteriological cultures revealed no pathogenic micro-organisms. Three weeks later the same clinical picture developed, once again followed by extensive surgical debridement. After a thorough diagnostic work-up an atypical mycobacterium was found, namely Mycobacterium abscessus--formerly named M. chelonei subspecies abscessus. Following appropriate antibiotic therapy the patient was symptom-free. Mycobacterial infections should be part of the differential diagnosis of persistent otorrhoea.