The document discusses various surgical procedures related to middle ear surgery, including myringotomy, myringoplasty, and mastoidectomy, detailing their objectives, indications, and complications. It covers the necessity of procedures for conditions like acute otitis media and eustachian tube dysfunction, as well as the materials used for grommets and grafts. Additionally, it outlines contraindications and complications associated with these surgeries, emphasizing the benefits of endoscopic techniques for improved outcomes.

1. January 30th, 2023
Middle Ear
Surgery
Halder Jamal

2. • Anatomy
• Myringotomy
• Myringoplasty
• Mastoidectomy
• Approaches
Objectives

6. Incision of the tympanic membrane with the purpose:
• To drain suppurative or nonsuppurative effusion of the middle
ear.
• To provide aeration in case of eustachian tube dysfunction
(may require ventilation tube “grommet” preferably placed in
the anteroinferior quadrant for longer retention).
Myringotomy = Tympanostomy

7. 1. ASOM
• Severe earache with bulging tympanic membrane.
• Incomplete resolution with opaque drum and persistent
conductive deafness.
• Complications of AOM: facial paralysis, labyrinthitis or
meningitis with bulging tympanic membrane...
• Recurrent AOM.
2. OME.
3. Aero-otitis media (to drain
fl
uid and “unlock” the eustachian tube).
4. Atelectatic ear (grommet is often inserted for long-term aeration).
Indications

9. Grommet, ventilation tube, pressure-equalizing tube or
tympanostomy tube
It is made of Te
fl
on or medical-grade silicon which are
biocompatible. Some grommets are made of gold or titanium.

11. • Injury to ossicles.
• Injury to jugular bulb with profuse bleeding.
• Middle ear infection.
• Related to grommet:
• Blockage due to blood or secretions.
• Middle ear infection.
• Extrusion.
• Persistent perforation after extrusion or removal.
• Tympanosclerosis.
Complications

12. • Myringoplasty: Closure of perforation of pars tensa of the
tympanic membrane. Advantages:
• Restoring the hearing loss.
• Preventing repeated infection from external auditory canal
and eustachian tube.
• Preventing aeroallergens reaching the exposed middle ear
mucosa, leading to persistent ear discharge.
• Tympanoplasty = myringoplasty + ossicular reconstruction.
Done in cases of ossicular disruption, missing bones…
Myringoplasty

13. Grafts:
1. Temporalis fascia
2. Areolar fascia overlying temporalis fascia
3. Perichondrium from the tragus
4. Cartilage
5. Vein
6. Periosteum
Endoscopic Myringoplasty. A: Endoscopic view of tympanic membrane perforation. B: After filling the middle ear with gelfoam through
the perforation, the graft is inserted with an underlay myringoplasty technique. C: Final graft position with underlay myringoplasty.

14. 1. Active discharge from the middle ear.
2. Otitis externa.
3. Ingrowth of squamous epithelium into the middle ear.
4. Nasal allergy. It should be brought under control before surgery.
5. When the other ear is dead or not suitable for hearing aid
rehabilitation.
6. Age < 3 years.
Contraindications

15. • Removal of diseased mastoid air cells.
• Indications:
• COM with or without cholesteatoma.
• Cochlear implant for SNHL.
• As an initial step in removal of lateral skull base neoplasms
(vestibular schwannomas, meningiomas, paragangliomas..)
• Complications of otitis media (intratemporal or intracranial).
Mastoidectomy

16. • Bleeding, Infection
• Hearing loss, Vertigo, Tinnitus
• Disturbance of taste (chorda tympani)
• Facial nerve weakness
• CSF leak
• Recurrence
Complications

17. • Ednomeatal (Transcanal)
• Endaural
• Postaural
Approaches

18. Endoscopic
• Wide
fi
eld, high resolution,
and a magni
fi
ed 2D view
• Less pain, faster recovery
with no scar.

20. ANK YOU!