Type II tympanoplasty - Clinical experience

Abstract

Introduction: Tympanoplasty associated to ossiculoplasty has the objective to reconstruct the tympanic membrane and the ossicular dynamics in order to restore the isolation of the middle ear and of hearing. Several materials have being used to recreate the sound transmission mechanism of the middle ear. The substitution or the reconstruction includes the use of biologic or aloplastic materials.

Materials and methods: The authors describe two reconstruction methodologies of the ossicular chain trough type II tympanoplasty making a comparative analysis between: 1) Use of PORP and 2) Use of shaped incus interposed between the stapes and the tympanic membrane.

Results: The use of partial ossicular replacement prosthesis (PORP) for interposition between the tympanic membrane and the stapes was used in situations of ossicular erosion or in situations where it was necessary to remove the incus and the malleus for a more effective control of the chronic infectious process. The shaped incus was used with the knowledge the the underlying disease was controlled. Myringoplasty was executed with temporal muscle fascia using underlay or overlay technique depending on the dimension and location of the tympanic perforation. Both alternatives were effective in what concerns recovery of the hearing loss.

Conclusion: The ideal prosthesis for ossicular reconstruction must be biocompatible, stable, secure, easy to use and capable of resulting in a better sound transmission. The prosthesis selection is related with all these factors associated to the pathology and the intraoperatory conditions. The aloplastic PORP’s and the autologous material prostheses have proved to be equally effective restoring middle ear function.