Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of ≥4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since this closure technique was adopted.

Malignant externa otitis is a potentially fatal disease in diabetic and other immunocompromised patients. Cerumen contains defense properties that protect the patient against infection. We tested the hypothesis that patients with diabetes mellitus have abnormalities in their cerumen that affect the environment of their external auditory canals and may predispose them to malignant externa otitis.

I have used this splint on 16 patients between November 1992 and July 1993. The device works as well as or better than other similarly designed thermoplastic nasal splints that are commercially available, and it is significantly less expensive. Commercially available splints run about 5 to 10 dollars per unit. This device as described costs approximately 50 cents per unit. This method of external splinting of the nose is extremely reliable and satisfactory to both myself and the patient. No splint is unobtrusive, and I have found that my patients like these bright and colorful splints.