Skip to main content Accessibility help

Intact bridge tympanomastoidectomy (I.B.M.)—combining essential features of open vs. closed procedures

  • Michael M. Paparella (a1) and Timothy T. K. Jung (a1)


In recent years, closed cavity intact wall tympanomastoidectomy or combined approached tympanoplasty—(CAT)—has been described and recommended by many. The pendulum now appears to be swinging back again to open cavity tympanomastoidectomy. Pertinent literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with the achievement of a dry safe ear while a concomitant but secondary objective is hearing retention and restoration utilizing tympanoplasty techniques. Over a three-and-a-half year period we have utilized a one-stage procedure which provides the desirable objectives of both open and closed cavity tympanomastoidectomy called intact bridge tympanomastoidectomy (I.B.M.). The salient features include: (1) good exposure, as in open cavity tympanomastoidectomy; (2) maintaining and widening the middle-ear space by bony bridge retention and facial buttress sculpturing, to enhance grafting and ossiculoplasty such as TORP or PORP, as in canal up tympanomastoidectomy; (3) enhancement of mastoid obliteration for large cavities, by blocking the aditus with bone pate or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques and results are presented and discussed. The results have been gratifying to date. In comparison to intact wall tympanomastoidectomy, this one-stage operation avoids the cost and discomfort of a second and sometimes third stage; surgery for recurrent pathology has been avoided and hearing results have been at least comparable if not improved.


Corresponding author

Department of Otolaryngology, Box 396 Mayo Memorial Building, University of Minnesota, Minneapolis, MN 55455, U.S.A.


Hide All
Brown, J. S. (1982) A ten year statistical follow-up of 1142 consecutive cases of cholesteatoma: The closed vs. the open technique. Laryngoscope, 92: 390395.
Cole, J. M. (1974) Conservative tympanomastoidectomy. Laryngoscope, 84: 783792.
Farrior, J. B. (1969) The canal wall in tympanoplasty and mastoidectomy. Archives of Otolaryngology, 90: 706714.
Holmquist, J. and Bergström, B. (1978) The mastoid air cell system in ear surgery. Archives of Otolaryngology, 104: 127129.
Jansen, C. (1968), The combined approach for tympanoplasty (Report on 10 years experience). Otolaryngology Head and Neck Surgery, 82: 779793.
B.F., McCabe, J., Sadé, M., Abramsen eds. (1977) Cholesteatoma: First International Conference, Birmingham, Aesculapius Publishing Company.
Ojala, K., Sorri, M., Sipila, P., and Palva, A. (1981) Post-operative cholesteatomas and retraction pockets after obliterative surgery in ears without cholesteatoma. Journal of Laryngology and Otology, 96: 411416.
Paparella, M. M. (1982) What have we Learned? Cholesteatoma and Mastoid Surgery, Amsterdam, Kugler Publications, 613618.
Paparella, M. M., and Kim, C. S. (1977) Mastoidectomy update. Laryngoscope, 87: 19771988.
Sheehy, J. L. and Patterson, M. E. (1967) Intact canal wall tympanoplasty with mastoidectomy. A review of eight years' experience. Laryngoscope, 77: 15021542.
Smyth, G. (1969) Combined approach tympanoplasty. Archives of Otolaryngology, 89: 250251.
Tos, M. (1972) Results of tympanoplasty with modified radical mastoidectomy. Acta Otolaryngologica, 74: 6165.
Yanagihara, N. (1982) Surgical treatment of Cholesteatoma: Problems in indications and technique. Cholesteatoma and Mastoid Surgery, Amsterdam, Kugler Publications, 483490.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed