Tympanoplasty and Ossiculoplasty

This chapter reviews principles and techniques for successful tympanoplasty and ossiculoplasty. Following a presentation of the fundamentals of middle ear mechanics, discussion centers on key components of patient evaluation and approach selection (transcanal, endaural, or postauricular). Special consideration is given to medial versus lateral techniques of graft placement (also known as underlay and overlay techniques), cartilage tympanoplasty, variations of myringoplasty, and surgery in special populations, including children. Next, the reader is guided to make decisions regarding the appropriate ossicular reconstructive technique based on assessment of the mobility, position, orientation, and integrity of the remaining ossicles. After reviewing the range of available autografts and allograft ossicular prosthetics, an algorithm is proposed for intraoperative decision making. Expected outcomes as well as factors predictive of success and failure are reviewed. Throughout the chapter, surgeons are encouraged to take a flexible approach, tailoring their techniques to best meet the needs of each patient.