Preservation of hearing in surgery for chronic ear disease† Consideration of Factors Involved

Myringostapediopexy: surgical expectation

“…During the middle of the last century it was recognized that there was variation in the hearing results following surgery for chronic suppurative otitis media, even among cases presenting with similar clinical ndings. 1,2 At the time Wullstein 3 described a system of tympanoplasty and reported results 4 showing the excellent closure of the air-bone gap that could be achieved with careful reconstruction of sound pressure transformation by myringostapediopexy. Similar results for myringostapediopexy have been reported by Pennington 5 and Proctor.…”

Advances in Preservation of Hearing of the Chronically Discharging Ear

“…When there was disruption of the incudostapedial joint, Juers 12 advised the removal of the head of the malleus and incus while Wright et al28 left the ossicles in place to preserve a good air space in the middle ear, placing a skin graft against the partially destroyed long process of the incus and head of the stapes.…”

“…We resort to the use of a graft only when the perforations of the tympanic membrane are of such a size that they cannot be closed by sliding flaps. The modified radical mastoidectomy was popularized by Bondy, Ballenger, Lillie, Shambaugh, and others 3,4,6,13,16,33,35-3« an{j achieved a greater scope by the contribu¬ tions of Lempert, House, Baron, and Juers.7"10, 12 Unfortunately, the operation is best suited for patients with perforations in Shrapnell's membrane and secondary cholesteatosis or relatively small marginal per¬ forations in the posteriosuperior quadrant of the pars tensa of the tympanic mem¬ brane.…”

“…12 Occasionally we were guilty of leaving granulation tissue in the ossicular chain or middle ear, with the hope of preserving the hearing. A dry ear was expected on the assumption that the major source of infection (attic and mastoid cells) had been eradicated.10 Much to our and other's40 chagrin, some of these patients with early successful results returned later, with a dis¬ charging ear and decreased hearing, leav¬ ing the patient with one other alternativea radical mastoidectomy.10 We were unable to close 15% of large central or so-called "nondangerous" perfo¬ rations of the tympanic membrane.…”

Prosthetics in the Middle Ear: Preliminary Report on the Use of Prosthetics to Reestablish Continuity of the Sound Pressure Transformer of the Middle Ear

“…3, F). 5. For patients with extensive otoscle¬ rotic involvement of the stapes footplate unsuitable for mobilization, or for cases that refix more than once after successful mobilization, the new technique of myringomalleolabyrinthopexy (Shambaugh) may be used instead of the classical Lempert fenes¬ tration.…”