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Three children whose eardrums appeared normal upon previous examinations, one with the otomicroscope, apparently developed tympanic membrane cholesteatomas that penetrated the fibrous layer of the pars tensa. Their histories all included episodes of acute otitis media, but no otorrhea. No otologic surgical procedures, including myringotomy, had been performed. These cases are thought to provide clinical support for the basal epithelial migration theory of cholesteatoma genesis. Rüedi's experiments suggest that cholesteatomas resulting from basal epithelial migration may not be visible for 18 to 30 days; thus, follow-up evaluations after acute otitis media should probably include examinations one and two months after the infection. Pediatricians and family physicians should be urged to seek otologic consultation for patients with even minor eardrum abnormalities, particularly those following infection.

Until recently, snoring had been considered both a medical enigma and a psychosocial problem. Snoring is now considered to be an acoustic phenomenon produced by vibration of the soft palate and the tonsillar pillars. We describe 20 patients with a clinical complaint of excessive snoring who were referred to rule out obstructive sleep apnea. All patients were without symptoms of daytime sleepiness and failure of the right heart. Twenty subjects were studied, 18 of whom were males. All subjects were monitored for one full night in the Sleep Laboratory. The apnea rate ranged from 9.0 to 94.0 incidents an hour with a mean of 30.0. Eight of the 20 subjects had obstructive episodes longer than 1 minute and three others had episodes longer than 55 seconds. Hypersomnolence, long thought to be a cardinal symptom, is not present in all patients with an ostensibly significant degree of obstructive sleep apnea.

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