Dear Dr. Sade,

Recently, I worked up a program for the American Academy of Otolaryngology, Head and Neck Surgery. My son, Laurence Buckingham, developed the software code. The two volume CD-ROM program consists of digitized otophotographs from my collection of various ear diseases. We have in this collection many cases of long term follow-up which adds a fourth dimension to the study of otoscopy, TIME.

The above otophotograph is the first in a case that I wish to show. The female patient was first seen in 1974 and last seen in April, 200l. The case was followed with multiple otophotographs and I thought to presume on you to study this series on your computer and let me know your opinions and ideas about the care of this patient if you are interested. (This case was not included in the two CD-ROM set mentioned above.)

The first photo seen above was taken in February, 1974. Below is the history of the first visit. On each of the subsequent pages, the findings and my diagnosis are detailed.

Date: February, 1974
History: The patient was a fifteen year old girl. There was drainage from this right ear which had drained only once previously one year prior following swimming. My diagnosis at the time was cholesteatoma and I prescribed some oil-based eardrops.

Hearing for speech frequencies is 30-45-20. Tomography shows partial clouding of a pneumatized mastoid with intact trabeculae and a soft tissue middle ear mass.