Ears, Hearing and Balance
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Ossicular Chain Reconstruction using bone cement. First, a piece of hyaluronate film (used later in the middle ear to decrease the inflammatory response during the healing process) is placed below the ossicular chain (and above the chorda tympani nerve) to minimize cement dispersion into the middle ear cleft. The gap between the incus and stapes (an eroded long process and absent lenticular process is seen here) in this female patient with a history of chronic ear infections, Eustachian tube dysfunction, and conductive hearing loss. Hydroxyapatite cement is used to carefully re-establish continuity between the eroded incus and intact stapes superstructure. Finally, the film is removed to reveal a hardened bond between the incus and stapes and gentle palpation of the malleus results in mobility of the incus/stapes complex. A lateral graft tympanoplasty was then performed to reconstruct the entire eardrum. This patient had improved hearing with near-complete closure of her previous air-bone gap.
In some types of ear surgery that includes an ossicular chain reconstruction, the surgical approach is through the ear canal (external auditory canal) and this is called an endaural approach.
In chronic ear surgery with a large eardrum defect (tympanic membrane perforation), damaged or absent ear bones (ossicles) associated with chronic infections and/or cholesteatoma, and mastoid disease, a combined approach with both a tympanoplasty and mastoidectomy are performed.
Ossiculoplasty and Lateral Graft Tympanoplasty in a male patient with mild canal atresia and abnormal ossicles. The canalplasty to enlarge the narrow external auditory canal has been performed. Palpation of the ossicular mass (fused malleus and incus) revealed fixation at the scutum. This connection was severed, resulting in a more freely mobile ossicular chain. Finally, pressed temporalis fascia was used in a lateral graft technique to created a new eardrum.