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Reconstruction of the sound conducting mechanism by the malleomyringoplasty and prosthesis method - Progress report
Abstract
In this progress report on a new tympanoplastic procedure for reconstructing a disrupted sound conducting mechanism characterized by destruction of the handle of the malleus, it is shown that by reconstructing a tympanic membrane and a handle of the malleus from a patient's own tissue and by utilizing a prosthesis for reconstituting the ossicular chain, it is possible to obviate all the difficulties experienced with the conventional malleus bypass procedures or with the use of a homograft tympanic membrane and ossicular chain. In all 21 cases reported, the tympanic membrane was successfully reconstructed in permanent continuity with the ossicular chain as a primary procedure. Interossicular continuity was also established with a wireclip or wireclip polythene tube prosthesis in 15 out of the 16 type 2, 3 and 4 cases with a mobile stapes, and the hearing was improved to a serviceable level. A second-stage procedure is required to connect the malleus replacement bone incorporated within the tympanic membrane to the oval window in type 3 cases with fixed stapes and in type 4 cases. The latter phase has not yet been completed and will be reported on at a later date.
