Chronic Otitis Media Pathogenesis Oriented Therapeutic Management

The history of surgery for chronic suppurative otitis media (CSOM) is littered with stories of techniques and materials that were tried with enthusiasm but without a reasonable expectation of long-term success. The early papers on tympanoplasty, and sadly even some still today, contain numerous short-term follow-up reports of new procedures that looked as if they might revolutionise ear surgery. By the nature of the problem, the longer-term results often proved to be poor and by the nature of humans, the original author didn't report this. As a result, perhaps hundreds of patients elsewhere were subjected to surgery that was already doomed to failure even before the operations started. The journals of the sixties and seventies contain many reports which most would rather forget. I began my otologic career in the early sixties, at the height of the otologic renaissance, and so often we felt that with just one more push conductive deafness would become a thing of the past. Now we know that the problems of middle ear reconstruction are multifactorial and that we are not simply looking for one single step to restore and maintain hearing and stability. What we need, is a greater understanding of why some procedures succeed and others fail. Happily in this book, Professor Ars and his team of leading clinicians and scientists, begin by looking at the ranges of causes of the problems. They then move on to examine the essentials needed for getting good results, and they do this in the light of those things which we know at the outset cannot possibly succeed. Professor Ars has gathered together an excellent group of otologists who start with the initial causes of the problems and move on to look for the essentials of success. Having identified these, they go on to explore how we can lay the foundations to achieve them. Finally, they look at the operative procedures they consider most likely to achieve success. This is an excellent book, which should improve the thinking behind surgery for CSOM. Alan G. Kerr, OBE, FRCS