Tracheostomy indication and patient diagnosis are significant variables that predict early decannulation in pediatric patients in whom tracheostomy is required. Other variables were not shown to be significant independent predictors.

A wide variety of pathologies arise from the petrous apex. Such lesions may present with symptoms caused by mass effect or cranial nerve palsies, or may be detected during an investigation for an unrelated disease. CT and MRI are complementary in providing an appropriate differential diagnosis and in aiding surgical planning. This pictorial review appraises the anatomy and contents of the petrous apex. Benign (e.g. cholesterol granuloma, cholesteatoma), inflammatory (e.g.apical petrositis) and dysplastic (e.g. Pagets disease) lesions of the petrous apex are discussed and illustrated. Whilst it is more frequent for neoplastic lesions to extend from adjacent structures, we demonstrate a variety of aggressive tumours and tumour-like conditions (e.g. metastasis, rhabdomyosarcoma, Langerhan's cell histiocytosis, endolymphatic sac tumour) that directly involve the petrous apex. A range of normal radiological appearances are seen, some of which may be mistaken for significant pathology (e.g. asymmetric marrow space development, simple effusions, cephaloceles). An imaging algorithm to aid the formulation of a differential diagnosis is also presented.

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We investigated the long-term outcome of patients requiring tracheostomy in an intensive care unit (ICU) in an attempt to identify risk factors that would indicate a low probability of early decannulation. A retrospective study was conducted of a consecutive series of 106 patients who underwent tracheostomy in the period between January 1, 2001, and December 31, 2001, during their admission to the ICU at the Royal Melbourne Hospital, Melbourne, Australia. There were 61 male and 39 female patients with a median age of 65 years. The indications for tracheostomy were prolonged mechanical ventilation (47), tracheobronchial toilet or risk of aspiration (45), and an unstable or obstructed airway (8). Thirty-seven patients died during the study period. All surviving patients were successfully decannulated (median cannulation time, 25 days). Patients with tracheostomies inserted for an unstable or obstructed airway had a significantly shorter cannulation time (median time of 13 days) as compared to the other two indications (mechanical ventilation, 25 days; risk of aspiration, 33 days; log-rank test, chi2(2) = 14.62 and p = .0007). Multivariate analysis showed that the effect of an unstable or obstructed airway was independent of the remaining group variables. We conclude that ICU patients who need a tracheostomy have a high mortality rate. Only the indication for tracheostomy insertion predicts early decannulation, and other patient variables are not significant predictors.

For patients with chronic suppurative otitis media or existing mastoid cavities, the obliteration with temporalis muscle or abdominal fat is an effective technique to facilitate safe cochlear implantation.