Tympanoplasty in difficult cases

Tympanoplasty in difficult cases
Alimohamad Asghari MD
Otologist-Neurotologist, Associate professor of IUMS, Rasool Akram Hospital, ENT, Head and neck surgery research center and department

Total, subtotal and anterior perforations of tympanic membrane (TM) have low take rate in tympanoplasties in comparison to other types of TM perforations.
Perforations which are limited or extended to superior-anterior part of TM are susceptible to fail after tympanoplasty. Lack of graft support, limited vascular supply
and less visualization are main reasons for low take rate. Different surgical technics were developed to increase the take rate in tympanoplasty in these cases. Overlay
technique, Loop Overlay, Hammock (or inferior flap or 270 degree) flap, Overlay- Under (or Mediolateral) graft and Bucket handle technique are main techniques which will present in this lecture. . Here we explain these techniques and share our experience. Marginal myringosclerosis and medialized malleus handle management will be discussed in this presentation.