\s=b\This cholesteatoma series comprises 84 ears, 81 of which had a labyrinthine fistula and 3 a horizontal semicircular canal opening that arose as a surgical complication. In 49 ears (58.3%), the operation was a primary one; in 35 ears (41.7%), it was a revision. Of all ears, 21 (25%) were deaf preoperatively. The fistula was located in the horizontal canal in 76 ears (90.4%).The matrix was removed in all these ears, and the fistula was covered with fibrin glue and fascia or periosteum. Hearing was preserved in all 57 ears in which matrix removal was carried out as the planned last stage. These included three ears in which the membranous canal was cut deliberately. Surgery that was performed against established rules caused deafness in three ears. Accidental opening of the horizontal canal caused no sensorineural loss in two ears as the fistulas were sealed immediately, while one ear in which the opening was not immediately recognized became deaf. (Arch Otolaryngol Head Neck Surg. 1989;115:804-806) Erosion of the dome of the horizon¬ tal semicircular canal, the most frequent site of a labyrinthine fistula, occurs in an overwhelming majority in patients with a cholesteatoma. Of the many factors that contribute to the erosion, the two most important are collagenase activity of the matrix1 and

Epidermal growth factor is an important modulator of cell growth, and its role in normal wound healing is well documented. Epidermal growth factor receptors have been identified in tympanic membranes of different animals. The ability of epidermal growth factor to promote healing of tympanic membrane perforations has recently been shown in experimental animals. We performed a double-blind, placebo-controlled study of the effect of epidermal growth factor applied locally on the tympanic membrane for 1 week in patients with chronic perforations. Seventeen adult patients took part in the study, eight in the epidermal growth factor group and nine in the placebo group. Three placebo-treated patients were later treated with epidermal growth factor, and five patients received repeated epidermal growth factor treatment. Perforation size was measured as a percentage of the tympanic membrane area before and at least 1 month (mean, 2.6 months) after treatment. One perforation in the placebo group healed completely, but none of the epidermal growth factor-treated perforations closed. Perforations became slightly smaller in both groups (mean decrease, 0.3% and 2.7% for epidermal growth factor and placebo, respectively), but these changes in size were not statistically significant for either group. At otomicroscopy, a proliferation reaction with thickening of the tympanic membrane and pseudomembrane formation at the perforation edge could be seen in some ears. Histologically, a sample from one epidermal growth factor-treated ear demonstrated signs of hypertrophic epithelium when compared with the morphology of a placebo-treated tympanic membrane. The only complications were two mild infections in the placebo group. Hearing remained stable after epidermal growth factor treatment.

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This study was conducted to evaluate the clinical usefulness of serum hCGβ in the diagnosis and prognosis of patients (n = 59) with cancers of the oral cavity and oropharynx. As a reference marker we used squamous‐cell carcinoma antigen (SCCAg). A blood sample was obtained from all patients before primary surgery. Serum hCGβ was determined by a time‐resolved immunofluorometric assay (IFMA) and SCCAg by a solid phase immunoenzymometric assay. Elevated preoperative hCGβ levels were observed in 8 (14%) and elevated SCCAg in 12 (20%) out of 59 patients. Patients with preoperatively elevated hCGβ had a shorter recurrence‐free survival when compared with those with normal hCGβ levels (log‐rank Chi‐squared = 6.83, p =.009), and the risk‐ratio for recurrence during follow‐up for those was 3.6 (95% CI = 1.29–9.94). In a Cox multivariate model hCGβ (p = 0.039) and stage (p = 0.044) were independent prognostic factors. SCCAg showed no correlation with recurrence‐free survival. We conclude that determination of hCGβ in serum is a potential marker in the prognostic evaluation of patients with SCC of the oral cavity and oropharynx. Int. J. Cancer (Pred. Oncol.) 84:525–528, 1999. © 1999 Wiley‐Liss, Inc.

There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.

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The results of surgery in a series of 452 ears having either myringoplasty (281 ears) or tympanoplasty (171 ears) were studied in relation to the experience of the surgeons. The trainees received an annual course in temporal bone dissection and were given daily surgical instruction in the operating theatre. The 142 ears operated by them showed less disease than those operated upon by the programme chairman (114 ears) and by the faculty (196 ears). The performance of the trainees was safe, and as to healed tympanic membrane and hearing results all studied parameters were statistically equal to those of the faculty. Repair of anterior perforations proved to be the most difficult and the overall results of both the faculty and trainees left place for improvement. On-line recording of surgical data and annual evaluation of an individual surgeon's results is suggested as a necessary means for continuous post-graduate training.

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