Asymptomatic osteomas of the middle ear.

Osteomas of the middle ear are extremely rare lesions. Of the nine cases reported, eight presented with conductive hearing loss. We recently treated two patients whose osteomas, of the promontory and of the posteroinferior tympanic wall, were asymptomatic.

Tympanostomy tube insertion: anterosuperior vs. anteroinferior quadrant.

We studied the extrusion rate of Paparella type I tympanostomy tubes in the anterosuperior quadrant compared to those placed in the anteroinferior quadrant in a prospective study. Thirty-five patients were evaluated. The duration (mean +/- SEM) in the anteroinferior quadrant was 211 +/- 18 days, whereas the duration in the anterosuperior quadrant was 211 +/- 11 days.

Microbiology of chronic sinusitis in children.

To better understand the factors involved in chronic sinusitis in childhood, we cultured the sinuses, middle meatus, and nasopharynx in 39 children requiring surgical intervention. Sixty-nine percent of these patients had other medical problems, including asthma (49%) and immunologic compromise (18%). We cultured coagulase-negative staphylococcus in 18 patients, Streptococcus viridans in 14 patients, normal flora in 10 patients, Staphylococcus aureus in nine patients, group D streptococcus in five patients, Corynebacterium in five patients, Haemophilus influenzae in three patients, Neisseria in three patients, and Streptococcus pneumoniae, group A streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella oxytoca, Propionibacterium acnes, Actinomyces, and an anaerobic gram-negative bacillus in one patient each.

Congenital and acquired facial nerve paralysis in children.

Facial nerve paralysis in children should be considered distinct from that which occurs in adults. The author submits a slightly different classification of facial nerve paralysis in children based on traditional thinking. Specifically, acquired facial nerve paralysis is thought to be influenced by both prenatal and postnatal factors.

Phenol as an adjuvant anesthetic for tympanostomy tube insertion.

The use of inhalational anesthesia for insertion of tympanostomy tubes in children provides no postoperative pain relief. Our retrospective analysis of children following tympanostomy tube insertion previously had shown significant postoperative elevations of blood pressure and heart rate in over 70% of cases. These changes, along with behavioral findings and complaints of discomfort, are suggestive of pain.