Tympanosclerosis

Patient Information on surgery

Incision

The various approaches in use are the post-aural & endaural methods. At times in a wide canal where the mastoid pathology is not to be addressed, an endomeatal procedure can also be performed. At our clinic we use the endaural approach almost exclusively.

A mini endaural incision is used which extends just half a centimeter above the tragus. By undermining, a mobile window is created, which can be moved on the outer surface of the mastoid & allows access form the attic to the tip.

Advantages:

•  The incision is closed by a single sub cuticular catgut stitch so the patients do not have to come back for stitch removal.

•  The usual post aural incision cuts many nerves so there is pain and stiffness, which may last for many weeks. This tiny incision is almost as painless as a stapedotomy.

•  Automatic meatoplasty

•  Quick opening & closing.

•  No risk of displacing musculoperiosteal flaps when closing.

•  No risk of gaping of the post-aural incision or a post aural fistula.

•  Direct access to the superior edge of the tragal cartilage (for ossiculoplasty)

•  Thin almost invisible scar

Tympanic membrane reconstruction is commonly performed using temporalis fascia either by the onlay or underlay technique, although a wide number of materials have been reported in the medical literature.

In our hands temporalis fascia is used by the interlay technique i.e. it is placed between the mucosal and fibrous layers of the drum remnant.

Onlay
The fascia is placed on the outer surface of the denuded drum remnant.

The Disadvantages of onlay are as follows:

Blunting
Lateralization
Epithelial Cyst formation

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