Tympanostomy tube placement has clearly been shown to be an efficacious treatment for recurrent bouts of acute otitis media or chronic otitis media with effusion. However, there are few objective, prospective, randomized studies present in the literature to aid the clinical otolaryngologist with the proper tube choice for middle ear aeration. A prospective, randomized study was undertaken of four commonly used tympanostomy tubes. Shepard Teflon grommet, Armstrong beveled tube, Reuter-Bobbin tube, and Goode T-tube. This study was undertaken to determine which of these tubes had the fewest number of postplacement complications, including otorrhea, plugging, residual perforation, or chronic persistence in the tympanic membrane. Average follow-up was 17 months. The Shepard and Armstrong tubes showed a comparatively low rate of plugging and otorrhea. Both tubes had extrusion times that averaged less than 1 year. The Reuter-Bobbin tube had a much greater rate of plugging, compared to the other tubes. The T-tube had an increased incidence of otorrhea and persistence in the tympanic membrane well beyond 1 year. The T-tube was also the only tube in this study associated with residual perforations.

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This study is based on the results of 221 subtotal gastrectomies for duodenal ulcer, and represents the combined opinions of a stomach study group composed of surgeons, internists, roentgenologists, pathologists, research fellows, and a member of the social service department. The social service department was added for the purpose of studying the economic conditions of peptic ulcer patients before and after medical treatment, as well as before and after operation. All patients were admitted, not as medical or surgical, but for the stomach group to dispose of, depending on the facts disclosed by the group study. At first there were differences of opinion as to the disposition of these cases, but as we learned from our experience, these differences disap-Fig. 1.-After the blood vessels have been divided and ligated in the region of the pylorus and duodenum, the anterior duodenal wall has been opened and the duodenal contents are being aspirated by suction.peared. Of late years there has been little question as to whether a patient should be continued on medical treatment or should be operated on.

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