Learning Objectives:
Introduction: In active Chronic Ear Disease (CED) and secuelae of CED without Cholesteatoma we perform Miringoplasties and Tympanoplasties without Mastoidectomy to reconstruct the sound transmission mechanism.
In this course we describe our surgical approaches and the materials that we use for the reconstruction of the ossicular chain. We tend to favor the use of autologous grafts whenever possible such as temporalis muscle fascia, tragal cartilage and remodeled incus. In some cases we also use titanium TORP and otologic cement depending on the existing viable remnants.
Material and method: For the purpose of this course we have revised 50 cases that had undergone Miringoplasties or Tympanoplasties. In the 50 cases we describe the procedure used to reconstruct the tympanic membrane and the ossicular chain depending on the pathology found in each case.
Results:
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1. - The most frequent approach has been retroauricular (85%).
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2. - In 50% of the cases the tympanic membrane was grafted with fascia (50%). In the remaining 50% the membrane was grafted with tragal perichondrium or periosteum obtained from the mastoid.
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3. - The graft was positioned in two pieces and overlaid to the despitheliazed tympanic remnants leaving the malleus handle between the two grafts (Double Overlay Graft, DOG).
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4. - The results showed that in 94% of the cases the tympanic membrane remained closed 3 years after surgery.
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5. - There was a significant hearing improvement in 80% of the cases. In those cases the residual air bone gap was less than 20 dB.
Conclusions: Miringoplasties and Tympanoplasties without Mastoidectomy have excellent results in the majority of cases. Both grafts take and hearing improvement is frequent enough as to recommend surgery as the best treatment choice. The adequate selection of cases for surgery, some technical aspects and thorough follow up of the patient are considered critical to obtain good and long lasting results.
