Myringoplasties and Reconstruction of the TympanicCavity Using a Silicone Sheet

Overview

The authors present an analysis of a group of 169 myringoplasties and reconstructionsof the middle ear implemented in the course of two years (1998-1999). 82 primary, simple myringoplasties were made and 41 re-myringoplasties on account of dry perforation of the tympanic mem-brane. The third group of the evaluated operations is formed by 46 myringoplasties “complicated”by the necessity of treatment of a pathological process in the middle ear and its reconstruction. Forplastic operations of the ear drum they use primarily usually a fascial free graft. The perichondriumor chondroperichondrium is used more frequently in reoperations or in concurrent reconstructionof the posterior wall of the auditory meatus. With regard to the technique of a soft transplant thetechnique of a removable silicone sheet is used, which was the case in 71 (42 %) operations. It servesabove all as support of the graft, also to prevent adhesions and for restoration of the mucosa of themiddle ear. The use of the silicone sheet increases with the size of the perforation and extent ofpathological findings in the tympanic cavity. In the majority of operated ears complete primaryincorporation of the graft occurred. The final anatomical results deteriorate as a result of secondaryperforations of the neomyrinx as a result of its late trophic changes. After a 6-30-month intervalfollowing healed ear developed (integral ear drum, unobstructed middle ear) in 63 (77 %) myringoplasties, 33 re-myringoplasties (80 %) and 38 (83 %) “complicated” myringoplasties. The authorsanalyze the causes of failure in different types of operations. The decisive factor for the outcome ofmyringoplasties is a correctly selected surgical technique and experience of the surgeon.

Key words:
myringoplasty, graft material, silicone sheet, results.