title: Lateralization of the tympanic membrane as a complication of canal wall down tympanoplasty: a report of four cases.
abstract: OBJECTIVE
  To describe the pathophysiology and treatment of the lateralized tympanic membrane that occurs after canal wall down tympanoplasty.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral hospital.
  
  
  METHODS
  Four patients in whom lateralization of the tympanic membrane developed as a complication of canal wall down tympanoplasty.
  
  
  RESULTS
  The patients had undergone middle ear surgery 20 to 34 years before their first visit to the authors. A Bondy operation with soft-wall reconstruction of the ear canal had been performed in three patients and a modified radical mastoidectomy in one patient. They all had severe conductive hearing loss. Common findings were anterior canal sulcus blunting, good tubal function, normal middle ear mucosa, and mobile stapes. At revision surgery, the lateralized tympanic membrane was removed, and the temporalis fascia was grafted medial to the malleus manubrium. The exposed bony surface in the ear canal was covered with a split-thickness skin graft, and the ear canal and the mastoid cavity were tightly packed to secure the graft. All the patients regained good hearing after the revision. Although deterioration of the anterior tympanic ring was presumed to be the primary cause of the graft lateralization, the lack of a posterior bony ear canal might have facilitated this condition.
  
  
  CONCLUSIONS
  Lateralization of the tympanic membrane can occur even in an ear with a radicalized mastoid cavity, especially when the anterior tympanic ring is torn and the posterior ear canal is reconstructed with soft tissue.
authors.affiliation: Department of Otolaryngology, Ehime University, Onsen-gun Shigenobu-cho, Ehime, Japan. kiyofumi@m.ehime-u.ac.jp
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Gyo
authors.forename: Naohito
authors.initials: N
authors.lastname: Hato
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shinomori
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hakuba
mesh_terms: D001844:Bone Conduction / Q000502:physiology; D002114:Calcinosis / Q000473:pathology; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002908:Chronic Disease; D004424:Ear Canal / Q000473:pathology / Q000601:surgery*; D005260:Female; D006314:Hearing Loss, Conductive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018058:Tympanic Membrane Perforation / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D014433:Tympanoplasty / Q000379:methods*