In this retrospective study of 130 ears over a 5-year period, the effect of intubation with the Goode T-tube was evaluated. The tubes improved the hearing in 86% of ears with a conductive loss secondary to a middle ear effusion to an average 5 dB airbone gap. They improved the early stage retracted tympanic membrane but had no effect on the established postero-superior retraction pocket. They were successful in treating barotrauma. The main complication with their use was otorrhoea which occurred in 28% of ears, and persistent perforation occurring in 6% of the ears. Seventy-seven per cent of tubes were in place after 36 months. Extrusion was significantly related to infection in the ear, and also to the presence of glue on insertion but there was no correlation between the number of previous grommets or the age of the patient. The Goode T-tube is advocated for use in middle ear effusion refractory to conventional grommet insertion or that due to cleft palate.

Several factors are known to affect the length of time a ventilation tube remains in the tympanic membrane. These include the design of ventilation tube, the insertion technique and the presence of intercurrent infection. In addition there are theoretical reasons to suggest that a ventilation tube placed superiorly should remain longer than one placed inferiorly. A randomised prospective study was undertaken on 54 children to test this theory. It showed that there is no significant difference in the extrusion rates for a particular type of ventilation tube (Shah grommet) when comparing the anterosuperior quadrant with the anteroinferior quadrant of the tympanic membrane.

Aspergillus infection of the nose and sinuses has been recognized for nearly 100 years but a variant, allergic aspergillus sinusitis, has recently been recognized. This non-invasive form causes chronic sinusitis characterized by thick green inspissated mucus in which eosinophils and Charcot-Leyden crystals are found. Fungal hyphae are scanty and are identified with special stains. Consequently the diagnosis may frequently be overlooked. It has many similarities with allergic broncho-pulmonary aspergillosis and is treated by surgical debridement and aeration with or without cortico steroids, either topical or systemic.

Eustachian tube dysfunction is thought to be one of the most important factors in the development of middle ear effusions. Direct measurement of Eustachian tube opening is not widespread in clinical practice. Evaluation of a new, small and cheap sonotubometer was carried out on 50 volunteers. The results were compared with the measurement of Eustachian tube function by tympanometry and show a high degree of correlation (P less than 0.001).

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