Surgical treatment of chronic otitis media

Ear surgery

There are 2 types of surgical procedures:

1. Remedial operation: the aim is to remove the pathological process (chronic otitis media with cholesteatoma, pyramidal tumor).
2. Reconstructive operation: follows rehabilitation, its aim is to restore the physiological function of the middle ear conduction system.

Surgical Approaches

• retroauricular approach - behind the pinna;
• endaural approach - through the ear canal;
• endomeatal approach - small incision is made in the ear canal in front of the eardrum.

In all 3 cases, these are microsurgical procedures (microscope, microsurgical instruments, bone cutter).

Remedial Operations

Rehabilitation services are divided into:

• Open: here we include the so-called tympanomastoidectomy, the principle of which is to remove the back and upper wall of the external auditory canal and create a large, dry, skin-lined cavity that opens into the ear canal. There will be a union of vaults in the processus mastoideus, antrum, tympanic and supratympanic cavities. However, we achieve better functional results with closed methods.
• Closed: the middle ear cavity remains separated from the external ear canal.
  • wall–up (we do not remove the back and upper wall of the ear canal);
  • wall–down (remove the back and upper wall and then recreate it using autologous (meatoplasty) or synthetic material).

Reconstruction operation

Myringoplasty

Myringoplasty is a reconstructive surgical procedure aimed at restoring the function of the eardrum. This involves either healing the eardrum or recreating it. In retromyringic myringoplasty, a free graft (autologous fascia from the temporalis muscle, perichondrium, cartilage) is placed under the eardrum (underlay).

Tympanoplasty

Tympanoplasty is a surgical procedure that tries to recreate a functional ear conduction system. It is classified among the so-called reconstructive operations, which are operations whose aim is to restore the function of the middle ear. As part of remedial surgical procedures, it is often necessary to remove the bone affected by inflammation (hammer, anvil). The defect created in this way must then be treated surgically - tympanoplasty.

In order to be able to indicate tympanoplasty, it is necessary that:

• the inflammation is completely eradicated;
• bone conduction is preserved;
• the Eustachian tube is functional;
• the middle ear mucosa is of good quality.

Classification of tympanoplasty

• Tympanoplasty I: the suprastructures of the stapes and manubrium of the malleus are preserved, the rest of the middle ear transmission system is replaced using a partial ossicular replacement prosthesis (PORP).
• Tympanoplasty II: all middle ear ossicles are missing, they are replaced by TORP (total ossicular replacement prosthesis).

Both autologous (cartilage, bone) and synthetic (plastic, metals, etc.) materials are used for the production of prostheses.

Before and after tympanoplasty

Links

Source

• BENEŠ, George. Studijní materiály [online]. ©2007. [cit. 2009]. <http://jirben2.chytrak.cz/materialy/orl_jb.doc>.

References

• KLOZAR, Jan. Speciální otorinolaryngologie. 1. edition. Galen, 2005. 224 pp. ISBN 80-7262-346-X.