IN the last decade hyperbaric oxygen has been recognized as an important therapeutic tool in a variety of instances in which either destruction of anaerobic bacteria is urgent or an improvement in the oxygenation level is mandatory. We have usede it successfully in a case of mediastinal anaerobic infection (gas gangrene) after medical and surgical measures had failed to eradicate the disease.

The causative organism of gas gangrene, Clostridium perfringens (Welchii), is widely distributed. It may be cultured from the soil, house dust, human skin and faeces, etc. For this reason infection with Clostridium is practically inevitable whenever suitable conditions arise. As an anaerobic bacterium Clostridium Welchii multiplies readily in damaged tissues without cantact with the air and devoid of a normal blood supply. This occurs especially in road accidents and war wounds in which broken bones and crushed muscles provide a suitable medium for the infection (Altmeier 1965). Sometimes this infection can occur too after abdominal or gynaecological operations (Hitchcock, 1965).

We present here a case of mediastinal gas gangrene which was caused by perforation of the oesophagus by a swallowed foreign body.

PHYSIOLOGICAL tympanostomy is advanced as a ‘substitute’ eustachian tube because it opens regularly only on swallowing, as does the ‘natural’ eustachian tube. The efficacy of the physiological tympanostomy operation was first proved in experimental animals (two dogs). Subsequently, six patients with eustachian insufficiency were successfully managed by this new surgical technique within period of one year, with no post-operative complications. The hearing improved and the middle ears remained air-filled.

The method seems to have the following merits: permanent ventilation of the tympanum with preservation of an intact drum (from the functional point of view); no tympanophonia or autophonia; simple technique, short operative period (five minutes); no risk of postoperative complications; and no danger of ascending infection of the middle ear from the ear canal. The demerits appear to be: drainage not ensured; no facility to increase the middle ear pressure by the Valsalva manoeuvre or, Politzerization.