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 (Jansen 2006), removing this armoring layer of gravel, boulders, etc. exposes the channel bed to the erosive force of the water. “On the Russian River near Healdsburg, California, instream pit mining in the 1950s and 1960s caused channel incision in excess of 3-6 m over an 11-km length of river” (Kondolf et. al. 2002). Tectonics play an important role in shaping landscapes and rivers, and tectonic uplift and river incision go hand in hand. Over geologic time, as mountains rise higher, water erodes deep gorges and channels, dissecting the landscape. In some instances, such as the Sierra Nevada mountains of