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Osteomas of the middle ear are extremely rare lesions. Of the nine cases reported, eight presented with conductive hearing loss. We recently treated two patients whose osteomas, of the promontory and of the posteroinferior tympanic wall, were asymptomatic. We suggest that middle ear osteomas need not be removed when they do not impinge on the sound conduction system.

The management of neonatal subglottic stenosis by the anterior cricoid split procedure (ACS) has evolved rapidly since this operation was first described by Cotton and Seid in 1980. Recent reports have specified criteria for the evaluation of patients for ACS, and adherence to these guidelines has increased the extubation rate and decreased the mortality rate in these series. Ninety-one patients have undergone anterior cricoid split at Children's Hospital Medical Center (Cincinnati, OH) since 1977. These cases were reviewed, emphasizing the 24 infants treated since January 1, 1988, and not previously reported. In comparison to our most recent report of 70% extubation and 10.4% mortality, 67% of the latest group were extubated, while mortality was reduced to 4.1%. These results were achieved despite some relaxation of strict patient-selection guidelines when this was appropriate in individual patients, emphasizing the need for careful clinical evaluation and close consultation between otolaryngologist and pediatrician in the selection of patients for ACS.

Tracheoesophageal puncture is not a complex procedure; nevertheless, significant complications are possible. In the last four years we have performed this procedure in 47 patients. Seven of them (15%) sustained significant complications related to the procedure. These included three cases of mediastinitis and sepsis, although surgical drainage was not required. Three other patients developed cellulitis of the trachea and root of the neck, centered around the tract through the party wall; one patient suffered a fracture of the cervical spine. Eight lesser complications also occurred. Tracheoesophageal puncture's simplicity and effectiveness surpass those of any other surgical procedure for voice restoration. However, our experience demonstrates that, as with any operation, the technique may be associated with significant operative complications.