The authors review 1,939 chronic ear surgeries in which 1,556 underwent some form of tympanic membrane grafting. The overall take rate was 93%. There was no selection of cases with regard to presence of infection, cholesteatoma, polyps, or granulation tissue at the time of surgery. There appeared to be no difference in the take rate based upon age of the patient, presence of infection, or cholesteatoma. Autogenous and homograft fascia performed well and there was no significant difference in take rate. Complications were minimal and were related more to the disease process than the grafting technique per se. In addition to reviewing the long-term follow-up of the original technique the authors present a method of dealing with tympanic membrane retraction pockets. Called a cartilage tympanoplasty this procedure incorporates a large piece of full thickness tragal cartilage with attached perichondrium into the substance of the tympanic membrane. With 2 years follow-up at this writing, this procedure has markedly reduced postoperative retraction pockets and recurrent cholesteatoma.

The clinical and diagnostic features of catecholamine secreting glomus tumors are reviewed. Three cases are reported, including the first documented case of a dopamine secreting glomus jugulare tumor. Based on this experience, the authors have outlined the indications for selective venous catheterterization studies and for pharmacologic blockage in the management of these patients. In addition to routine urinary screening, a high index of clinical suspicion is needed to avoid the complications associated with catecholamine secreting tumors.

Inflammation of the facial nerve in Bell's palsy can be demonstrated on gadolinium-enhanced magnetic resonance imaging. We have studied a series of 17 Bell's palsy patients with gadolinium-enhanced magnetic resonance imaging, and the purpose of this paper is to report our findings and discuss their significance. Most acute Bell's palsy cases demonstrate facial nerve enhancement, usually in the distal internal auditory canal and labyrinthine/geniculate segments. Other segments demonstrate enhancement less often. Gadolinium enhancement occurs regardless of the severity of the paralysis and can persist after clinical improvement of the paralysis. The findings of this study corroborate other evidence that the segments of the facial nerve most often involved in Bell's palsy are the only segments that are most often enhanced with gadolinium-enhanced magnetic resonance imaging. The role of gadolinium-enhanced magnetic resonance imaging in the management of Bell's palsy patients is discussed.

Osseous hemangiomas are distinctly unusual tumors of the skull base. They clinically mimic other, more common lesions in this region, and their diagnosis is rarely made preoperatively with currently available techniques. Three cases of osseous hemangiomata, 2 involving the geniculate region and 1 arising from the jugular bulb, are described in relation to the perioperative assessment and management of these lesions. A review of 21 previously reported skull base hemangiomas is included.

Basic fibroblast growth factor (bFGF) has been shown to enhance speed of wound repair at a number of anatomic sites. This study presents an evaluation of bFGF in a model of acute tympanic membrane (TM) perforation in order to assess rate of healing as well as structural and functional outcome. Perforations were created in the tympanic membranes of rats, then allowed to heal in the presence of topically applied bFGF with the opposite ear serving as a control. The growth factor was applied in repeated doses beginning 2 days after creation of the TM defect. The treated ears healed faster by an average of 4.0 days. The healed tympanic membranes were assessed using tympanometry and light microscopy. Structurally and functionally, the healed tympanic membranes were similar to the controls. The observed results indicate that bFGF promotes accelerated healing and restoration of normal architecture in acute TM defects.