In recent years, closed cavity intact wall tympanomastoidectomy or combined approached tympanoplasty—(CAT)—has been described and recommended by many. The pendulum now appears to be swinging back again to open cavity tympanomastoidectomy. Pertinent literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with the achievement of a dry safe ear while a concomitant but secondary objective is hearing retention and restoration utilizing tympanoplasty techniques. Over a three-and-a-half year period we have utilized a one-stage procedure which provides the desirable objectives of both open and closed cavity tympanomastoidectomy called intact bridge tympanomastoidectomy (I.B.M.). The salient features include: (1) good exposure, as in open cavity tympanomastoidectomy; (2) maintaining and widening the middle-ear space by bony bridge retention and facial buttress sculpturing, to enhance grafting and ossiculoplasty such as TORP or PORP, as in canal up tympanomastoidectomy; (3) enhancement of mastoid obliteration for large cavities, by blocking the aditus with bone pate or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques and results are presented and discussed. The results have been gratifying to date. In comparison to intact wall tympanomastoidectomy, this one-stage operation avoids the cost and discomfort of a second and sometimes third stage; surgery for recurrent pathology has been avoided and hearing results have been at least comparable if not improved.

This study consisted of the evaluation of the plain X-ray findings of films taken at early follow-up (mean 1.5 months after surgery) and at late follow-up(4–14 years after the early films) of 211 ears which had been operated on radically and obliterated. Residual cells which were detected on the basis of the early films were associated with a more frequent occurrence of post-operative infection and were thus hallmarks of a poorer prognosis. Changes in the bone surrounding the surgical cavity and the radiological quality of the walls of the surgical cavity, the presence of new bone formation in the cavity and other radiological features did not yield useful information about post-operative complications. New bone formation was associated with a smaller amount of post-operative cavitation. Post-operative X-ray examination of the obliterated ear is a prognostically useful examination, but it does not significantly contribute further to the information available by clinical and otomicroscopic examination in regards to the complications of infection and cholesteatoma.

Fifty children aged between five and eight years of age who have had proven otitis media with effusion have been retrospectively assessed. Twenty-five children who had attended the Casualty Department with head injuries, who have had X-radiography of their skulls as part of their investigation, acted as controls. All the children in this group were selected because they had no otological history.

The 50 Children comprising the retrospective survey were split into two groups: Group 1, with recurrent secretory otitis media requiring surgical intervention on more than three occasions; Group 2, comprising 25 children who had had up to three surgical interventions.

All the children had PA X-radiography of their skulls in order to demonstrate the bony nasal septum. In Group 1, a septal deformity was found to be sited at the middle third of the bony septum at the vomero-ethmoid suture. In Group 2, the deformity was found to involve the whole of the middle third of the bony septum, plus portions of the upper and lower thirds of the bony septum.

In the control group, in whom there was no history of otological disease, there was no deformity sited at the middle third of the bony septum.

Initial optimism about the successful outcome of treatment of congenital syphilitic deafness with ampicillin and steroids has always been tempered with an awareness of the uncertain long-term results. This paper is a review of 16 patients treated with various combinations of ampicillin and steroid; these have been followed up for periods of five to 14 years. Ampicillin alone does not prevent progressive hearing loss in the majority of patients. Ampicillin combined with prednisone, or with prednisone and ACTH, has preserved the hearing in all but two ears which had useful hearing before treatment The fact that the hearing in many of these ears, although maintained continues to fluctuate still gives cause for concern.