There is a difference of opinion about treating traumatic perforations of the tympanic membrane expectantly or with early surgery. Those who treat expectantly argue that most of the perforations will heal, given enough time. Those who argue for early closure note the occasional finding of middle ear damage, high closure rates, and faster healing. We present 50 consecutive traumatic perforations seen over a 3-year period and initially treated with paper tape patches (3M Micropore) applied in the office under local anesthesia. The success rate was 92%. Three of the four patients whose treatments failed, presented with a draining ear the night of patch placement, suggesting prior infection. All four failures were successfully treated with myringoplasties. Surprisingly, meticulous attention to aligning the perforation margins did not appear to affect the outcome. Healing usually occurred within 2 to 3 weeks. We contend that this method of treatment is quick, inexpensive, highly successful, identifies potential complications, is accepted by most patients, and promotes early healing.

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Multiple factors are associated with the increased risk of postoperative complications following radical neck dissection. Most significant of these are preoperative radiation and entry into the pharynx. The most common of these complications are discussed, and following is a description of preoperative, intraoperative, and postoperative methods to reduce them. Changes in operative methods and antibiotic coverage were associated with a decrease in wound infection and fistula formation. It is suggested that patients in high risk categories be covered with preoperative, prophylactic gram positive antibiotic coverage, along with Tobramycin.

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