No abstract

Much debate exists over the management of mucosal chronic suppurative otitis media in children, with the majority of it centred around the correct timing to perform either a myringoplasty (an operative repair of the tympanic membrane) or type I tympanoplasty (reconstruction of the tympanic membrane when there is an intact and mobile ossicular chain). Further discussion will use the term tympanoplasty to mean both of the above definitions. We present the findings of a recent survey of UK ENT consultants questioning their opinions on various management aspects of mucosal CSOM in the paediatric population. We also present an extensive review of the literature to provide us with published evidence in order to analyse the results of the questionnaire.

The data suggest cautious use of MMC in clinical situations when wound breaking strength is critical.

Debate has currently re-emerged following a renewed warning issued from the Committee on the Safety of Medicines (CSM) regarding the relative risk of ototoxicity from the use of aminoglycoside-containing drops in patients with tympanic membrane perforations. We present the findings of a survey of ENT consultants, questioning their views and current practice, and we add to the debate by means of a review and discussion of the literature.

RF) was the essential part of tongue reconstruction. Methods: RF originates from the infrahyoid muscles and was dissected during the neck dissection procedure as a uni-or bilateral flap. RF was indicated in 71 patients (14 female, 57 male). The youngest was 21, the oldest 71 years of age (mean, 52.8; median, 53; STD, 9.9 years). The majority of our patients had advanced stages of disease (T1, 1; T2, 24; T3, 28; T4, 18).Results: Tumor resection required a transmandibular (55), transpharyngeal (5), transoral (4), or a pull through ( 7) approach. The defect to be closed was situated in the oral tongue (3), tongue base (28), or both (40 patients). Minimal morbidity resulted in 20 patients in whom a complete defect closure was achieved with the RF. Combined procedures of defect closure (radial forarm flap with or without free fibula transfer, 37; jejunal graft, 9; upper arm flap, 4; iliac crest, 1) were indicated for the majority of patients. Speech and swallowing was restored to an acceptable rate. Preliminary experimental and histological studies revealed that innervation of RF via the deep cervical ansa is essential to prevent unintentional atrophy of the flap.Conclusions: RF serves as a reliable tool for tongue reconstruction with a minimal tendency to shrink. In combination with free vascular tissue transfer the flap is ideal to close larger defects.