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The following editorial and solicited commentary about the editorial concern an important aspect of nomenclature for otologic surgery. We hope that this editorial will encourage the further discussion and application of criteria for classification of tympanoplasty.—B.R.A.

In reviewing the history of the development of modern surgical procedures designed to manage chronic otitis media, one cannot help but be impressed by the fact that the surgeon has always been faced with two primary considerations: control of the disease and conservation of the patient's hearing. Pursuing the matter further, it becomes clear that these two surgical aims are often in direct conflict, for control of the disease usually involves extensive removal of tissue, which in turn leads to further loss of hearing. What was true in the pioneer days of mastoid surgery is still true today. It is therefore my wish to discuss the status of these two conflicting goals in the surgical treatment of chronic otitis media and to suggest a point of view which is in consonance with our present-day experience with this most difficult and challenging aspect of otologic surgery. Since the end of the

On occasions, the otologist is confronted with the possibility of performing surgery on the ear of a patient with useless or no hearing in the opposite ear. Because any surgical procedure on a patient's ear may result in further loss of hearing or even total deafness in the operated ear, an ill-advised operative procedure in such a patient may result in a catastrophe. Up to 2 percent of patients undergoing surgery for otosclerosis develop further severe sensori-neural hearing losses in the operated ear. Idiopathic sudden deafness in patients following stapedectomy can occur for causes unrelated to surgery. Further loss of hearing can also occur after simple myringoplasty and tympanoplasty. Such a possibility must be considered and to a great degree should influence the otologist's decision as to whether or not surgery is indicated, and if so, what is the surgical procedure of choice? A deaf patient can be compared to a blind patient only superficially, and not at all when it comes to any consideration of surgery upon the remaining organ of hearing and vision. Consider the patient with total blindness in one eye who cannot be helped with glasses. Should blindness of any degree affect the remaining eye, an operative procedure which can restore vision may be the only recourse. On the other hand, should the patient with only one hearing ear lose some hearing acuity in that ear, it may always be corrected or helped by the use of amplification. Therein lies the great difference. Total deafness cannot be helped by a hearing aid, and such a catastrophe cannot be risked when any other choice is available. This must be the guiding principle of all otologic surgeons in such instances.

FOR this lecture in memory of George Morrison Coates, it is fitting to choose a subject that is in the forefront of otosurgical interest. It is easy to forget that in the beginning the operation that revolutionized otologic surgery, the one-stage fenestration operation, was vigorously opposed by nearly all of the leaders in otology. Dr. Coates and Dr. James Babbitt of Philadelphia, almost alone of the senior otologists of that time, recognized this new procedure as a significant advance and gave their full support to the small group of Lempert's early students who met once a year as the Otosclerosis Study Groups. Until his death, Dr. Coates attended each meeting of this group, lending his mature judgment to the discussions. For this lecture, I have chosen to discuss the endolymphatic sac, a neglected part of the auditory mechanism, nearly forgotten by the clinician and ignored by the otologic surgeon. The

Background Atlantoaxial rotatory fixation is a condition in which the first and second vertebrae of the cervical spine become interlocked in a rotated position. This condition can result in serious consequences and thus have a significant impact on patients, especially when diagnosis and treatment are delayed. Some cases of atlantoaxial rotatory fixation have been described in association with otologic surgery or plastic surgery involving the ear. We present the cases of two pediatric patients who developed atlantoaxial rotatory fixation following otologic surgery and we review the relevant literature. Case presentation One patient was a 7-year-old boy who underwent tympanoplasty for cholesteatoma. The other patient was a 5-year-old girl with profound sensorineural hearing loss who underwent cochlear implantation. Both patients developed atlantoaxial rotatory fixation on the day after surgery, and they were treated conservatively. Our literature search using relevant terms identified 12 similar published cases. Thus, a total of 14 patients, including our 2 patients, were evaluated. Most of the patients were children and typically they complained of painful torticollis and exhibited a characteristic posture called the “cock-robin” position on the day after surgery. Mostly, the direction of torticollis was opposite to the side of surgery. Most of the patients received conservative treatment alone, but three underwent surgical treatment. Conclusion The correlation between the direction of torticollis and the side of surgery suggests that rotation of the head during surgery has an impact on development of postoperative atlantoaxial rotatory fixation. Thus, children undergoing otologic surgery are thought to be at a risk of postoperative atlantoaxial rotatory fixation. Although rare, the surgical team needs to be aware of this adverse event and pay close attention to this possibility throughout the perioperative period. Perioperative management should include informed consent, preoperative assessment of the range of head and neck motion, proper intraoperative positioning and monitoring of the position, and postoperative follow-up. Postoperative atlantoaxial rotatory fixation is not completely preventable, but good perioperative management can minimize the damage resulting from this condition. Electronic supplementary material The online version of this article (doi:10.1186/s13037-016-0116-7) contains supplementary material, which is available to authorized users.

Delayed facial nerve palsy (DFP) is rarely experienced after otologic surgeries that do not directly touch the facial nerves, such as tympano-mastoidectomy, cochlear implants, and stapes surgery, and is troublesome to both surgeons and patients if it happens. Here, we report 7 cases of DFP, including one case that developed DFP after endolymphatic sac surgery. The ratios of occurrence were as follows: 0.7% (2/305) for tympano-mastoidectomy, 0.8% (3/354) for cochlear implant, 0.4% (1/260) for stapes surgery and 1.0% (1/98) for endolymphatic sac surgery. All otologic surgeries, except for endolymphatic sac surgery, exposed the chorda tympani, and all surgeries, except for stapes surgery, underwent drilling for a mastoidectomy. Furthermore, DFP was always observed ipsilaterally to the operated ear after otologic surgeries and was never seen after benign parotid tumor surgery or total laryngectomy. Therefore, there may be a strong relationship between DFP and the procedures, used during otologic surgeries.

It has been three decades since the operating microscope for otologic surgery was introduced into the United States. Today's surgical microscope is used not only for surgery but also for still photography, motion pictures, and videotape recordings. The needs of photography are such that additional fiberoptic light sources or strobe flash units are often attached to the operating microscope for illumination during photography. Each accessory uses a cord or cable to its electrical source, causing a myriad of cords to be serried alongside the extension arms of the microscope. Multiple cables frequently become entangled and create drag, which restricts the mobility of the microscope. A cable-carrying guide system of stainless steel rods shaped into open spirals of approximately one and one-half turns is described. The system contains the accessory cords while permitting full mobility of the microscope during surgical procedures.

Modification of horizontal opening alligator forceps has been developed. In my experience, this instrument has made certain maneuvers in otologic surgery easier.

A common observation during otologic surgery under general anesthesia, notably with nitrous oxide, is tympanic membrane graft displacement due to elevated intratympanic pressure. We mean that nitrous oxide increases the intratympanic pressure. We measured the intratympanic pressure changes with the Madsen impedance measuring instrument ZO 73. The results of the measurements of 84 ears are discussed and the tendencies of the connection between pressure in the middle ear and the size of the mastoid bone are shown.

This superbly illustrated book by 13 mostly European authors will be a necessity for any student or practitioner of ear surgery. The volume carries an excellent translation by P. M. Stell of Liverpool, England. The material on preoperative diagnostic procedures and indications for surgery and the references are adequate, but the book in general suffers from a short, telegraphic style. Helpful to the student of surgery are the various descriptions and illustrations of new and standard instruments of otologic surgery, a mundane topic frequently overlooked. I particularly enjoyed the text by Marguth on neurosurgical procedures of interest to the otologist. The chapters on otogenic infections, intracranial complications, and basal skull surgery are excellent, while chapters on foreign body removal, malignant external otitis, and radical mastoid surgery are brief and weak. Important otologic concepts, such as intact canal wall techniques, surgery for Bell's palsy, and mastoid surgery, are too briefly and

• Proximity of the cerebral cortical veins to the overlying dura predisposes them to surgical injury. Labbe's vein, draining a major portion of the posterior temporal and inferior parietal lobes, occurs on the left in 77% and on the right in 66% of patients. Interruption of this vein during otologic surgery may produce devastating neurologic consequences. In this regard, the roentgenographic anatomy of cerebral cortical venous drainage is reviewed. Technical treatment of the temporal dura should include those techniques familiar to the neurosurgeon that ensure the protection of the temporal lobe and its superficial venous drainage.

A short review of past techniques and materials used in treating the totally disabled middle ear is presented. Basic principles to be observed in management of this problem are discussed and the method of middle ear rehabilitation using the double layer Silastic technique is introduced. Cases (231) are reviewed with comments on the functional results achieved. It is concluded that a reliable total ossicular replacement prosthesis has yet to be produced.

This is a collection of papers from the proceedings of the First International Symposium on Biomaterials in Otology held from April 21-23, 1983, in Leiden, the Netherlands. The book provides a comprehensive review and a critical evaluation of several biomaterials that are used in otologic surgery. The book has four major sections: a history of middle ear implants—studies that relate to fundamental aspects of biomaterials in otology, plastic implants, and ceramic implants. A list of several plastic and ceramic materials by product name, generic name, composition, appearance, and types of prostheses are given at the end of the book. There are several excellent studies that deal with the basic aspects of the use of a variety of plastics and ceramics in animals and the outcome of total and partial ossicular replacement prosthesis (TORP and PORP) in human subjects. Many readers will be surprised by the data on long-term hearing results

The editors have compiled the formal presentations, the commentaries during surgical demonstrations, panel discussions, and question and answer discourses of a group of prominent otologists and audiologists at an international symposium held at the University of Minnesota Health Sciences Center in June of 1970. This volume presents an authoritative review of recent advances in otologic surgery and medical therapy as well as clinical issues in audiology. The contributors have stressed practical rather than theoretical aspects of their topics. The first several chapters deal with preoperative evaluation and audiologic diagnosis and rehabilitation. The surgical management of otosclerosis, microtia and congenital atresia of the external auditory canal, chronic otitis media, and serous or secretory otitis media is discussed in formal presentations and in the surgical commentaries. The diagnosis and treatment of diseases of the vestibular system are briefly touched upon. The final part is an excellent group of presentations on the pathology

This is the first revision, seven years after the initial publication of one of the world's outstanding texts on otologic surgery. The original format has been retained. This includes a historical introduction to each chapter followed by a carefully considered presentation of the subject matter, including excerpts from key papers, based on the author's extensive experience and contributions in the field. Dr. Shambaugh is uniquely qualified to develop such a text since his own extensive career in otologic surgery spans the pre- and post-antibiotic eras and the evolution of modern otologic surgery. Many chapters have been extensively revised to keep abreast of current developments in areas such as surgical treatment of endolymphatic hydrops, management of malignancies, tympanoplastic techniques, and labyrinthine fistulae. Two new chapters have been added, one on tomography of the temporal bone and the other on acoustic neuroma and tumors of the cerebellopontile angle. The text is extensively

Earlier issues of theArchivespublished in full the first three workshops on ear surgery, held at Northwestern University in 1959, 1963, and 1967. The Fourth Workshop on Microsurgery of the Temporal Bone sponsored by the Mid-America Hearing Research Foundation was held March 21 to 26, 1971. The program was designed to bring to the practicing otologist the recent advances in otologic surgery, by an Organizing Committee consisting of Drs. Bobby R. Alford, Houston; Hugh O. Barber, Toronto; Richard J. Bellucci, New York City; Jack D. Clemis, Chicago; Eugene L. Derlacki, Chicago; Fred R. Guilford, Houston; Wiley H. Harrison, Chicago; William F. House, Los Angeles; Brian F. McCabe, Iowa City; Bruce Proctor, Royal Oak, Mich; George A. Sisson, Chicago; and George E. Shambaugh, Jr., Chicago, chairman. Program speakers included 63 from the United States and 15 from abroad: Canada, England, Ireland, Sweden, Switzerland, Holland, Belgium, France, Australia, and West Germany

Of late the technic of otologic surgery has steadily improved. Some of the advances in this line have already been generally accepted, while others are only regarded tentatively, or are not fully recognized. I consider only those improvements that are not accepted by all otologists and that have not yet been incorporated into their routine work. These improvements are largely connected with the physiologic treatment of wounds which materially shortens the convalescence and notably improves the results. 1. The advantages of a thorough mastoid operation are great. In this operation not only all the diseased tissue in sight is removed, but also the whole mastoid process ablated, and the zygomatic, occipital and jugular cells, if present, are opened, to expose all the cellular diverticula of the middle-ear system. The advantages are that there is no possibility that the convalescence will be much delayed by any remnant of the infected material