Otolaryngology has seen a rapid proliferation of functional endoscopic sinus surgery, and there is variability in the teaching of the procedure, in part because of the seriousness of the complications. A retrospective review of 106 consecutive cases was conducted at a teaching program to evaluate complications. Complication rates were combined and compared with the reported complication rates of other teaching programs and practicing otolaryngologists. The complication rate in our program was 13.9%; all were minor complications. This compared favorably with the rates of other programs (6% to 29%). The combined complication rate for residency training programs (16.6%) was significantly greater than the nonresident complication rate (10.5%). When divided into major and minor complications, the resident minor complication rate (15.9%) was significantly greater than the nonresident rate (8%), yet the major complication rates were significantly less for the resident group (0.7%) than for the nonresident group (2.5%). In addition, complications were significantly greater when procedures were performed under general anesthesia as compared with local anesthesia, and estimated blood loss was significantly greater under general anesthesia.

A total of 53 anatomical specimens of the posterior ethmoid and the adjacent anterior sphenoid sinus wall were examined in reference to the operative guidelines for endonasal sphenoidotomy. Six anatomical points of measurement were defined for clinical orientation, and both the absolute and the relative widths of each third (i.e. of each of three vertical sections) of the pars nasalis and the pars ethmoidalis of the anterior sphenoid sinus wall determined. The choana proved to be the most valuable regional anatomic landmark. In 43 cases (41%), a pervading ethmoidal cell was found, extending superiorly and medically all the way up to the nasal septum. In contrast with certain guidelines reported in the literature, 18% of the specimen (sides) showed a wider pars nasalis in the vertical middle third of the anterior sphenoid sinus wall as compared to the adjacent pars ethmoidalis. The thickness of the bone in the anterior wall was similar in both areas. The present measurements support Wigand's recommendation (1990) that the anterior sphenoid sinus wall be perforated paramedially, 10 mm superiorly to the choana.

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O~ectives: Comparison of intraoperative saline irrigation to otic drops in the prevention of postoperative otorrhea in chlJdren with middle ear effusion undergoing bilateral myringotomy with ventilation tubes. Study Design: This study was designed as a bH.nded, controlled, prospectively randomized trial. Methods: Study children were randomly assigned to receive either otic drops for 3 days postoperatively or saline irrigation of the middle ear space at the time of myringotomy. Only children with effusion present at the time of surgery were included. All children were evaluated for drainage 7 to 14 days postoperatively, and the degree of drainage was graded from 0 to 4. Results: Of the 84 patients entered into the study, 62 patients were eHgible for data analysis (16 failed follow-up, 6 records were lost). Of the patients who completed the s tudy, not all had bilateral effusions, resulting in 111 ears for inclusion in the study. Fiftytwo ears underwent irrigation, and 10 were noted to have otorrhea (19.2%). Fifty-nine ears received otic drops, resulting in 21 ear s with otorrhea (35.6%). Evaluating the degree of otorrhea with a five-point Leichert scale, the average score per ear was 0.42 for the saline irrigation group and 1.07 for the control group. The rate and degree of drainage were both statistically r duced in the saline irrigation group (}' < .05). Conclllsions: Using middle ear irrigation at the time of tympanostomy may be more effective than antibiotic drops in preventing postoperative otorrhea.

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