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Monday, February 21, 2005

AIPG 2003 ENT Myringoplasty

69. A 5-year-old boy has been diagnosed to have posterior superior retraction pocket cholesteatoma. All would constitute part of the management, except:
1. Audiometry.
2. Mastoid exploration.
3. Tympanoplasty.
4. Myringoplasty.
4. Myringoplasty.
Logan Turner Page 289
Fundamentals of Ear, Nose, Throat and Head and Neck Surgery - S.K.De - 7th Edition Page 123
Diseases of Ear, Nose and Throat. – P.L.Dhingra - 2nd Edition Pages 35,75
Ear Perforations can be regarded as safe if they are central perforations or Tubotympanic type and unsafe if they are of attico antral type or associated with cholesteotoma. This boy in our Question has “Unsafe” type of CSOM. The objectives of the surgical management will be to
1. To remove the disease focus
2. To reconstruct the ear as far as possible, but not at the cost of objective 1.
The management of such cases would consist of
1. Evaluation – Radiological and Audiometry
2. Atticotomy
3. Modified Radical mastoidectomy
4. Tympanoplasty
1. Audiometry is needed for medicolegal purposes as we are doing a destructive or quasidestructive surgical procedure and we want to document that the patient already had a hearing loss as a consequence of the disease
2. Mastoid exploration is an essential part of management.
3. Tympanoplasty is done for reconstruction.
4. Myringoplasty is not done in cases of Unsafe Ear. It is done only in cases of Safe ear
Let us see the types of tympanoplasty


Central perforation

Repaired with a
graft. Also called as
IIPerforation of TM
with Erosion of Malleus
Graft is placed on
Incus or remnant of Malleus
IIIPerforation of TM with Absence of Malleus

and Incus
Graft is placed
directly on head of Stapes

IVOnly Foot plate of
Stapes is present
Graft is placed in
Foot plate of Stapes
And round window is
VFoot plate of Stapes
is fixed. And Round window is

Another window is
created in the horizontal canal

Also called as
Fenestration Operation

Myringoplasty is done is safe ear or tubotympanic type or central perforation

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