Introduction: Major ear surgery can be safely performed on a day case basis (i.e. six hour stay). This study aimed to ascertain whether patients had the same level of satisfaction and speed of recovery following major ear surgery when it was performed as a day case compared with performance as an in-patient procedure.

Method: A cross-sectional survey, by postal questionnaire, of patient satisfaction with day case and in-patient major ear surgery was carried out with 158 patients. Comparisons were made between the responses of the two groups.

Results: The response rate was 71 per cent. Patients returned to work significantly sooner following day surgery (p < 0.025) but felt their operation to be of significantly more benefit following in-patient surgery (p < 0.05).

Conclusions: Patient satisfaction following day case major ear surgery is as good as that following in-patient surgery. This has supported the expansion of this service in our unit.

We describe an endaural technique for soft tissue and bony meatoplasty and canalplasty in the surgical management of chronic otitis externa unresponsive to medical treatment and out-patient microsuction. Following analysis of the surgical outcome via a retrospective review of patient records, we would recommend this surgical treatment in this patient group.

Sinus radiographs have been carried out on 240 new cases of childhood otitis media with effusion (OME). When the films were suggestive of infection, maxillary sinus washouts were carried out as part of the surgical treatment. Abnormal X-rays were obtained in 28 per cent of the study group, but only 16 cases (seven per cent) of sinus infection were confirmed on antral lavage. In those with positive washouts, there was an apparent relationship between the findings in the maxillary sinuses and middle ears of the same side in some of the cases. There was also evidence of improvement of the middle ear disease when the sinus infection was successfully treated. It does not appear that sinus infection is an important cause of OME, though it may be relevant in a small number of cases.

The finding of granulomata in nasal polyps is rare. In this report we describe a case with necrotizing granulomata occurring after surgery. The differential diagnosis of such a finding is discussed.

We report a retrospective study of 54 children with 57 involved ears who underwent surgery for cholesteatoma before their sixteenth birthdays. The majority of these underwent open cavity operations (modified radical mastoidectomy, radical mastoidectomy or atticotomy). The incidence of residual disease was only 6 per cent and overall 70 per cent of ears have been free of chronic discharge. The post-operative hearing thresholds were disappointingly low, though overall no worse than those recorded before surgery. The mean post-operative hearing level for the group was 39 dB and the mean air-bone gap was 29 dB. Open cavity surgery is the method of choice for childhood cholesteatoma, mainly because of the low incidence of residual disease.

The number of operations for cholesteatoma, together with the number of cases undergoing insertion of ventilation tubes in the Tayside region of Scotland between 1966 and 1986 have been studied. During this period there has been a sixty fold increase in the use of ventilation tubes, but the incidence of cholesteatoma surgery has only varied between 0.94 and 1.88 operations per 10000 of population per year. The mean annual incidence of cholesteatoma during this period was 1.32 cases per 10 000 of population. The results indicate that there has been neither a rise nor a fall in the incidence of cholesteatoma in Tayside despite a considerable increase in the use of ventilation tubes.

A case of hyperextension fracture of the hyoid bone is presented. The management is discussed, with reference to the mode of injury, emphasizing that symptomatic treatment only may be necessary. The literature is briefly reviewed.