Tympanoplasty with mastoidectomy: present status.
There are many problem areas in tympanoplasty surgery. For the most part the extent of the problems relates directly to how vigorously one pursues a good functional result: the harder the surgeon tries, the more problems he may have. There are also many controversial areas in tympanoplasty, most of which relate to technique. In regard to tympanic membrane grafting and management of the sound pressure transfer mechanism, how well the surgeon performs the operation is far more important than which of the variety of techniques he uses. In relation to obtaining an air-containing mucous membrane-lined middle ear space and the management of the mastoid, there are many philosophical and emotional factors. There are many ways to manage the mastoid in cholesteatoma surgery, all of which can be successful if properly performed. We use all procedures but prefer the intact canal wall technique. The major advantage of the intact canal wall procedure is that the surgeon may avoid a post-operative mastoid cavity. The main disadvantages of this technique are the problems of recurrent and residual cholesteatoma, problems that necessitate a two-stage procedure in the majority of patients.
D002781:Cholesteatoma / Q000601:surgery*; D004427:Ear Diseases / Q000601:surgery*; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D009225:Myringoplasty; D011183:Postoperative Complications; D012008:Recurrence; D014433:Tympanoplasty / Q000379:methods*