[One-stage total auricle reconstruction combined with simultaneous formation of the external ear canal and tympanoplasty--report of 40 cases].
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This paper is a comparative study of the early and late functional results of tympanoplastic operations, as modified by Khan. Following such surgery, we examined 494 patients who had been operated on between 1970--1972 in the ENT Clinic of the Free University of Berlin (Klinikum Westend). Preliminary and final hearing results were recorded with the aid of sound audiograms, which were critically assessed by two different types of evaluations. These included the results of pure-tone changes and speech reception thresholds as achieved by the tympanoplastic operations. On the basis of socially useful hearing improvements, the functional results of cases operated in our clinic are above average. The hearing gain shown from post-operative controls to the final studies is especially satisfactory, since this also includes an improvement in bone conduction.
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Transplants composed in three layers of tragus cartilage and perichondrium are ideally suited for eardrum transplants. They are easily prepared, well-nourished, stable and withstand retraction tendencies due to negative middle ear pressure. One overlapping perichondrium layer forms, so to speak, the live rail for the eardrum epithelium. To this perichondrium layer the cartilage disk is safely attached. The cartilage disk attached to its outer perichondrium layer--also covered by the perichondrium towards the middle ear--is thus fastened like a circular tape in the eardrum frame similar to the foot plate of the stapes. The eardrum seal is safe; in 87 operations we observed only one case of the edge coming away which was due to the transplant being too small. This type of transplant has proved its worth especially when reconstructing the ossicle chain with column protheses (TORP, PORP). The excellent hearing results may be explained by the optimum transformation of air pressure from the large cartilage via the medium-sized prosthesis screen, which is attached to the surface, to the small foot plate of the stapes. The "tragus" transplant can also be used in case of a Type III interposition of incus.
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A brief review of the use of plastique prostheses in ossiculoplasty, as well as the use of homograft tympanic membranes along with our experience is reported. Plastipore prostheses have been found to be useful, and their continued use is advocated. Homograft tympanic membranes are useful in repairing those ears which have undergone extensive damage to the tympanic membrane and ossicles.