Tympanocentesis was performed in 28 pediatric patients with chronic recurrent suppurative otitis media. The purulent aspirate was cultured aerobically and anaerobically. Aerobes only were isolated from 4(14·3 per cent) patients; five (17·9 per cent) had only anaerobes and 19 (67·8 per cent) had both aerobes and anaerobes. There were 36 aerobic isolates. P. aeruginosa was recovered in 16 patients. Other aerobes commonly recovered included Proteus sp. and S. aureus. There were 38 anaerobes isolated. Anaerobic Gram-positive cocci were isolated in 23 instances. Eleven Bacteroides sp. were recovered, including 4 B. fragilis group and 5 B. melaninogenicus. All of the patients were treated with clindamycin in a dose of 30 to 40 mg per kilogram per day divided into 3 dosages for a total period of 14 to 21 days (average 17 days). When Gram-negative enteric aerobic rods were also recovered in substantial numbers, an aminoglycoside (gentamicin) was added to the therapy (in 12 patients) and administered parenterally for 7 to 10 days. The patients' response to the therapy was excellent in 7 cases, good in 9, fair in 3 and poor in 9. There were no diarrhea episodes or colitis noted and there were no other sideeffects due to the therapy. The above findings demonstrate the polymicrobial etiology of chronic recurrent suppurative otitis media and suggest that medical treatment directed against the aerobic and anaerobic bacteria isolated from the patients' ear aspirates could eradicate the infection completely in more than half of the cases.

Stenosis of the tracheostoma after total laryngectomy can be prevented by the addition of a simple Y-incision to the U-incision for total laryngectomy. This technique ensures a wide stoma, eliminating the need of tracheal cannulation even immediately after surgery

Bullous myringitis is considered to be a self-limiting disease without complications. Clinical evidence has shown it to be frequently accompanied by sensorineural hearing loss, more often than it was thought to be.

The case of a 20-year-old girl is presented in whom bullous myringitis was accompanied by transient sensorineural hearing loss. The site of the lesion was determined to be in the cochlea. We determined, with a high degree of certainty, that the causative agent was mycoplasma.

In two patients with Wegener's granulomatosis, treatment-resistant serous otitis media was followed by unilateral facial nerve palsy. Later both patients developed uraemia due to extracapillary glomerulonephritis. In one of them, who was treated with prednisone and cyclophosphamide, renal function improved, while in the other patient it remained impaired. Both patients suffered lasting hearing impairment in spite of general improvement during the course of the disease. The facial nerve palsy improved slightly in one, while no improvement was seen in the other.

The possibility of Wegener's granulomatosis or other autoimmune collagen diseases should be considered in cases of treatment-resistant serous otitis media. Early diagnosis and treatment can possibly save the patient from the lifethreatening consequences of these diseases.