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 dyked for flood control and to plant crops in the floodplain (Doyle, et al.). Normally, floods are allowed to spread out across the floodplain, allowing deposition of sediment and slowing water speeds, reducing the erosive potential of the water (Heiler, et. al. 1995). Channelization concentrates flood flows down the active channel, increasing erosion. River incision due to agriculture is well-documented throughout the agricultural regions of the world, such as the Central Valley of California (Florsheim, et. al. 2011). In-stream gravel mining is also well documented as a cause of river incision. Stable material on the river bed mitigate erosion