Myringostapediopexy after tympanomastoidectomy.A 53-year-old man presented with chronic otitis media Chronic otitis media Inflammation of the middle ear with signs of infection lasting three months or longer. Mentioned in: Myringotomy and Ear Tubes chronic otitis media in the right ear and a cholesteatoma in the right ear. Audiometric testing revealed a high-frequency sensorineural hearing loss Sensorineural hearing loss Hearing loss caused by damage to the nerves or parts of the inner ear governing the sense of hearing. Mentioned in: Tinnitus sensorineural hearing loss in both ears and a mixed hearing loss in the right ear. The speech reception threshold was 50 dB in the right ear and 30 dB in the left; speech discrimination scores were 92% in the right ear and 100% in the left. Weber testing lateralized to the right. The air-bone gap on four-frequency pure-tone audiometry was 18 dB. The patient underwent a canal-wall-up tympanomastoidectomy. Acholesteatoma sac was found intraoperatively; it filled the middle ear and epitympanum but did not involve the mastoid. The mastoid was pneumatized. The incudostapedial joint was totally eroded, so the head of the malleus was removed and the incus was discarded. The stapes stapes /sta·pes/ (sta´pez) [L.] the innermost of the auditory ossicles; it articulates by its head with the incus and its base is inserted into the oval window sta·pes n. pl. was mobile. Underlay temporalis fascia grafting was performed without placement of Silastic Silastic /Si·las·tic/ (si-las´tik) trademark for polymeric silicone substances that have the properties of rubber but are biologically inert; used in surgical prostheses. sheeting but with a plan to perform ossicular reconstruction at a later date. During postoperative follow-up, the patient was noted to have a shallow retraction with a myringostapediopexy (figure). Myringostapediopexy, a term popularized by Juers, (1) is also known as a type III tympanoplasty tympanoplasty /tym·pa·no·plas·ty/ (tim´pah-no-plas?te) surgical reconstruction of the tympanic membrane and establishment of ossicular continuity from the tympanic membrane to the oval window. in the Wullstein classification. (2) In the variation of type III tympanoplasty discussed here, the underlay fascia graft is placed directly onto the stapes capitulum capitulum /ca·pit·u·lum/ (kah-pit´u-lum) pl. capi´tula [L.] a small eminence on a bone, as on the distal end of the humerus, by which it articulates with another bone. . Another variation of type III tympanoplasty involves placement of a columella Columella (Lucius Junius Moderatus Columella) (kŏl'yəmĕl`ə), fl. 1st cent. A.D., Latin writer on agriculture, b. Gades (now Cádiz), Spain. (such as a partial ossicular reconstruction prosthesis) from the tympanic membrane to the stapes capitulum. In the case described here, four-frequency pure-tone audiometry at the 1-year follow-up revealed that the patient's air-bone gap was only 13 dB. In view of the good heating result, no immediate ossicular reconstruction was planned, and follow-up at 6-month intervals was scheduled to monitor the retraction. [ILLUSTRATION OMITTED] References (1.) Juers AL. Preservation of hearing in surgery for chronic ear disease; a consideration of factors involved. Laryngoscope 1954;64(4): 235-51. (2.) Wullstein H. The restoration of the function of the middle ear, in chronic otitis media. Ann Otol Rhinol Laryngol 1956;65(4): 1020-41. |
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