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Whatever changes have occurred during the past decade in our method of operating have involved chiefly the treatment of the flaps or soft parts. When men differ as to technic they differ usually in advocating either the old wide-open; gauze-packed wounds, with which we are all familiar, or some form of closed or partially closed wound.Undoubtedly a growing respect for the soft parts in mastoid surgery has led to some modifications of surgical method. I shall try to show that these changes have not been haphazard, but rather the logical outgrowth of a better appreciation of laws governing wound repair. THE BONE OPERATION. —With minor differences to be noted later, the bone operation of ten years ago was practically that in use today. Posterior drainage from the vault and thorough removal of diseased bone, in whatever direction and to whatever distance this might lead, were then, as now, recognized

In responding to your committee's invitation to prepare a paper on this particular subject, my first impulse was to decline the task as presenting too many difficulties. The subject is manifestly too broad to be adequately outlined in a single paper. I hope, however, that my paper may serve the purpose of inducing a larger and more useful discussion by others.Chronic catarrhal otitis media is an elastic term, rather indefinitely applied to a variety of tympanic conditions, which are, perhaps, best considered under the following headings:1. Chronic tubal catarrh, without marked tympanic changes other than those due to retraction of the membrana tympani.2. Chronic hypertrophic otitis media.3. Chronic hyperplastic otitis media; dry middle ear catarrh; otosclerosis.Obviously no classification is of practical value which divides these cases into groups which can not be recognized clinically. The differential diagnosis is not easily reduced to any system

The title of this paper is clearly open to criticism. Deafness is a symptom and not a disease. To the patient, however, the symptom is the disease, and our treatment is of value to him only in proportion to its influence on audition. Applying the same test, are we as aurists satisfied with our results? Taking as a standard the treatment as outlined in text-books and as practiced in most aural clinics, can we claim as the net result the actual relief of a reasonably large percentage of cases?While this paper is concerned chiefly with one type of deafness—that is, the deafness of ossicular rigidity —it may not be amiss to mention briefly some of the commoner forms of deafness from other conditions:Deafness due primarily to a lesion of the labyrinth or auditory nerve. Such lesions are fortunately rare as compared with those of tympanic origin. They are

I think the majority of experienced otologists will confirm my statement that severe vertigo resulting from middle ear suppuration without labyrinthine involvement is not sufficiently common to call for prolonged discussion here. At least, the distinguishing features of the vertigo in such cases may be more profitably analyzed in connection with special case reports. The following conditions, however, require passing mention:1. A few cases of chronic middle ear suppuration have been observed or reported in which granulations in the region of the oval window and pressing on the stapes have caused vertigo which has been relieved by careful removal of the granulations. 1 recall one such case which I saw with Dr. Harmon Smith in which operation later was successfully performed by the late Dr. Sheppard of Brooklyn. The diagnosis of this condition would, in most cases, be tentative prior to operation. It could be determined with some degree