title: Type IV tympanoplasty revisited.
abstract: OBJECTIVE
  There has been a great improvement in the material and design of prosthesis used for total ossicular reconstruction in recent years. As a result, the indication for type IV tympanoplasty has become more restricted. The long-term follow-up of type IV tympanoplasties performed by the author is presented.
  
  
  METHODS
  This is a retrospective study of 31 patients who had type IV tympanoplasties performed by the author at the ear, nose, and throat clinic of a district general hospital.
  
  
  METHODS
  All the patients had chronic active otitis media with total loss of ossicles that were unsuitable for ossicular reconstruction.
  
  
  METHODS
  The preoperative and postoperative air and bone conduction thresholds of all the patients who underwent type IV tympanoplasty were measured.
  
  
  RESULTS
  Twenty-six percent of the patients had a postoperative hearing level <40 dB and 58% had an air-bone gap <30 dB. The indication for type IV tympanoplasty can be categorized into four groups: severe atelectasis, patients with cleft palate, erosion of the footplate, and surgery on the better-only hearing ear.
  
  
  CONCLUSIONS
  There still is a place for type IV tympanoplasty in modern otology.
authors.affiliation: The Ipswich Hospital, Department of Ear, Nose and Throat, Suffolk, United Kingdom.
authors.forename: M W
authors.initials: MW
authors.lastname: Yung
mesh_terms: D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold; D001844:Bone Conduction; D002908:Chronic Disease; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D009998:Ossicular Prosthesis; D019933:Ossicular Replacement / Q000295:instrumentation / Q000379:methods*; D010033:Otitis Media / Q000150:complications / Q000601:surgery*; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D014433:Tympanoplasty / Q000145:classification / Q000295:instrumentation / Q000379:methods*