Myringotomy 1886. The vinyl tube used today was introduced by Beverley Armstrong in 1954. There are numerous indications for tympanostomy in the pediatric age group, the most frequent including chronic otitis media with effusion (OME) which is unresponsive to antibiotics, and recurrent otitis media. Adult indications differ somewhat and include Eustachian tube dysfunction with recurrent signs and symptoms, including fluctuating hearing loss, vertigo, tinnitus, and a severe retraction pocket in the tympanic membrane. Recurrent episodes of barotrauma, especially with flying, diving, or hyperbaric chamber treatment, may merit consideration. Myringotomy is usually performed as an outpatient procedure. General anesthesia is preferred in
River incision and diverse ecosystems on the planet and are for this reason the focus of many restoration projects throughout the United States. At low erosion rates increased stream incision may make gentle slopes to erode creating convex-up forms. Convex slopes around a stream can thus indirectly reflect accelerated crustal uplift. This is because accelerated incision may trigger accelerated erosion on the adjacent slopes creating slopes progressively steeper slopes that are in equilibrium with high erosion rates. River incision River incision is the narrow erosion caused by a river or stream that is far from its base level. River incision is common