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Our results are comparable to the huge variation in available literature. We note the higher revision rate following modified Chongchet technique. Both techniques had a low and acceptable rate of post-operative analgesia and antiemetic requirement. We are considering either otoplasty technique as a day surgery procedure within our unit with the provision of adequate patient support as a safe and economical advance.

A 47-year-old Australian man of Vietnamese origin presented to hospital 3 days after returning from a 2-week pilgrimage to Nepal and India in January 2012 with a 10-day history of fever and myalgia. He had developed high-grade fever with chills and rigors associated with myalgia 7 days after arriving in Nepal. Two days later, he developed nausea and vomiting. He had been vaccinated for hepatitis B and cholera before travel. He was not taking prophylactic antibiotics. He travelled with a group of 10 others who remained well. He recalled receiving a few mosquito bites, and noted rodent infestation and stray dogs in some of the temples he visited. A doctor in the group treated him empirically with oseltamivir after his initial symptoms began. A rash developed 2 days before his admission and 9 days after the onset of symptoms.The main fi ndings of an examination on admission were a high fever (40°C), a macular erythematous rash over his trunk and extremities sparing his palms and soles, and facial fl ushing. There were no eschars.Laboratory investigations on admission showed a platelet count of 44 10 9 /L (reference interval [RI], 150-450 4 Raoult D, Weiller PJ, Chagnon A, et al. Mediterranean spotted fever: clinical, laboratory and epidemiological features of 199 cases. Am J Trop Med Hyg 1986; 35: 845-850. 5 Cascio A, Dones P, Romano A, Titone L. Clinical and laboratory fi ndings of boutonneuse fever in Sicilian children. Eur J Pediatr 1998; 157: 482-486. 6 Walker DH. Rickettsiae and rickettsial infections: the current state of knowledge. Clin Infect Dis 2007; 45 Suppl 1: S39-S44. 7 Lee N, Ip M, Wong B, et al. Risk factors associated with life-threatening rickettsial infections. Am J Trop Med Hyg 2008; 78: 973-978. 8 Cascio A, Colomba C, Di Rosa D, et al. Effi cacy and safety of clarithromycin as treatment for Mediterranean spotted fever in children: a randomized controlled trial. Clin Infect Dis 2001; 33: 409-411. 9 Breitschwerdt EB, Davidson MG, Hegarty BC, et al. Prednisolone at anti-infl ammatory or immunosuppressive dosages in conjunction with doxycycline does not potentiate the severity of Rickettsia rickettsii infection in dogs.