This technique has been successfully used by the two senior authors (JW and MK) for many years. For the purposes of this article, we have prospectively looked at 15 ears (10 consecutive patients) that have been suctioned between September and October 2008. Patient age ranged from 3 months to 36 months (mean 14.3 months old, median 11 months). Eight ears had a mucoid discharge and seven ears had pus. The tympanic membrane was visible post suction in 13 ⁄ 15 ears giving a success rate of 87%. In the two ears where the drum was not visible, a large proportion of the discharge was removed allowing successful treatment with topical antibiotics and accurate assessment of the drum 2 weeks later. This technique is a practical and quick method of aural toilet particularly in infants. It can also be used in older fractious children. It is especially useful when the ear canal is occluded with pus. In some cases, it may also avoid list- ing patients for an ‘Examination under anaesthesia of ears’. Keypoints • Suction using a microscope or ‘dry-mopping’ the ear canal can be technically difficult in this age group and cause distress to the child. • A technique of aural suction using a flexible suction catheter is described; it can be used with a child lying down or sitting in their parent’s lap. • This technique was used prospectively on 15 ears (10 consecutive patients) that had either a mucoid discharge or pus in the external auditory canal; the tympanic membrane was visible in 13 ⁄ 15 (87%) of the ears post-suction. • We propose that this technique is a practical and quick method of aural toilet particularly in infants. • It may prevent the necessity for examining the ears under a paediatric general anesthetic in certain cases. Conflict of interest None to declare. Permacol in augmentation rhinoplasty: how we do it Hopkins, C., Walker, R., Lee, S. & Roberts, D. ENT Department, Guy’s Hospital, Great Maze Pond, London, UK Accepted for publication 10 October 2008 Dear Editor, Rhinoplasty surgeons often wish to implant graft materi- als into the nose, to either augment the tip or nasal Fig. 3. Suction catheter is held at the anti-tragus for greater control of the tip. Correspondence: Claire Hopkins, Carmay, Cheslfield Lane, Orpington BR6 7RR, Kent, UK. Tel.: +44 207 188 2215; e-mail: clairehopkins@ yahoo.com 68 Correspondence Ó 2009 Blackwell Publishing Ltd • Clinical Otolaryngology 34, 64–75