Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.

This technique is an excellent method of repairing many defects of the helical rim. Its advantages include technical simplicity, little risk of tip necrosis, patient convenience, and superior cosmesis.

An algorithm was developed for nasal tip reconstructions based on the size and location of tissue defect. Both the recipient and donor sites were analyzed for aesthetic result and complications.

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The use of the island rotation flap for the repair of small and medium-sized partial-thickness defects of the nasal tip and soft triangle has led to extremely favorable aesthetic results far superior to that of full-thickness skin grafts. The color and thickness match have been excellent, and the complication rate was negligible. The aesthetic results and reliability, coupled with the single stage and single operative site, make this flap an excellent option for nasal tip reconstruction. It is our procedure of choice for the reconstruction of small and medium-sized nasal tip and soft triangle defects.