PMID: 8588661Sep 1, 1995Paper

Middle ear mechanics of type IV and type V tympanoplasty: II. Clinical analysis and surgical implications

The American Journal of Otology
S N MerchantM E Ravicz

Abstract

Type IV and type V tympanoplasty operations are simple, robust, and well-established techniques to reconstruct middle ears that have been severely altered by chronic otitis media. In a previous paper, the authors developed a simple four-block physiologic model to describe hearing results after these procedures. This paper presents a comparison of model predictions to hearing results obtained from a detailed retrospective clinical review of 30 type IV and type V procedures. Audiograms predicted by the model and those observed clinically show good agreement over a wide frequency range (500-4000 Hz) and for many different clinical conditions. Thus, this model reliably predicts postsurgical hearing results. The application of quantitative analyses provided by this model permits the formation of a few simple surgical rules that may improve postoperative hearing results. (1) The footplate should be left as mobile as possible (e.g., by covering it with a very thin split-thickness skin graft, as opposed to a fascia graft, which will tend to stiffen it). If the footplate is ankylosed, it should be removed and replaced with a compliant tissue graft, such as fat. (2) The round window acoustic graft shield should be made as stiff as possib...Continue Reading

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