A Historical Review of Indian Perspectives on Techniques of Tympanoplasty

Abstract

Reconstructive surgery of the conductive hearing mechanism is collectively called as tympanoplasty, which has gradually evolved over time with the contributions from all over the word. The aim of the present historical review is to summarize the Indian contributions in the development of the technique of tympanoplasty. The literature review was conducted using only the “Medline” search using keywords “tympanoplasty” and “ossiculoplasty” in “India” on 15th June 2016. A total of 195 articles and abstracts were found dated from the year 1998 onwards. Articles describing work on technique were included, and those describing only experimentation with graft material were excluded. All articles were fully read and analysed. It was found that there had been experiments regarding the choice of anaesthesia and the use of combinations of different chemical agents for this purpose. There were suggestions in favour of monitored anaesthesia care for the surgery in select patients. Surgeons expressed their perspectives on the time and conditions for the surgery, laterality of surgery, different types of incisions, use of endoscopes, graft placement techniques, ossicular replacements with autologous or allogenic grafts, and the timing of prophylactic antibiotic therapy given after or during the surgery. The range of work is wide and covers most of the aspects of surgery; however, the incorporation of a uniform methodology and standards reporting results were lacking in the articles reviewed.

Efficacy of middle-ear packing in success of type 1 tympanoplasty: a prospective randomised study

“…Graft uptake rate ranges from 60 to 100 per cent in different studies and usually depends on surgeon and patient factors. 13 In our study, the observed graft uptake rate was 97.5 per cent in gelfoam and 100 per cent in non-gelfoam groups, respectively (Table 2). One patient in the gelfoam group got otitis media on the 18th post-operative day resulting in a small residual perforation which persisted even after three months.…”

“…The success of tympanoplasty was measured on the basis of graft uptake rate and hearing improvement. 13 The main purpose of using gelfoam is to support the newly placed graft which is held in its place by the surface tension force, keeping it affixed to tympanic membrane remnant for its epithelisation. Otherwise, the graft usually tends to fall down in the middle ear because of negative middle-ear pressure.…”

Materials for ossicular chain reconstruction: History and evolution (Review)

“…The first attempts of ear surgery were documented in 1640 when Banzer attempted a tM reconstruction using a pig's bladder. Jasser was a pioneer of mastoid surgery in 1776; however, after an unfortunate incident in which the personal physician of the King of Denmark died of sepsis following this type of surgery, ear operations were discredited and went into oblivion for at least another hundred years (18,19). In 1853, toynbee rediscovered mastoid surgery and several attempts at a tympanic reconstruction were made by physicians, such as Blake in 1877 and Berthold in 1878 (18,19).…”

“…Jasser was a pioneer of mastoid surgery in 1776; however, after an unfortunate incident in which the personal physician of the King of Denmark died of sepsis following this type of surgery, ear operations were discredited and went into oblivion for at least another hundred years (18,19). In 1853, toynbee rediscovered mastoid surgery and several attempts at a tympanic reconstruction were made by physicians, such as Blake in 1877 and Berthold in 1878 (18,19). However, none of these pioneers considered the reconstruction of the ossicular chain, probably due to the lack of adequate optic equipment and anatomical knowledge of the area.…”