Management of the Ossicles in Tympanoplasty: Consideration of Techniques

Abstract

In many situations of tympanoplasty, it is difficult to maintain or reestablish ossicular continuity while at the same time achieve adequate exposure for removal of disease. Methods of assessing and treating the ossicles in tympanoplasties Types I, III and IV are discussed. A special situation occasionally occurs where the ossicles are normal and intact in the presence of extensive middle ear disease. A technique can be used which affords a wide middle ear exposure. It consists of removing and subsequently replacing an anterior canal skin flap, drum, malleus and incus as a “unit”. In addition, special situations requiring Type V tympanoplasty using a total stapedectomy approach are discussed.