Staged surgery in ears with excessive disease of tympanum.

Results regarding tympanic healing and hearing improvement are reported in a series of 84 one-stage operations on the middle ear, using thin silicone elastomer sheeting, and of 76 two-stage operations using temporary filling of the middle ear with paraffin wax, and of ten with silicone elastomer sponge. All epithelium was removed from the tympanic cleft at the primary operation. Staging of the operation gave better hearing results and resulted in fewer adhesive middle ears. Middle ear mucosal biopsies from ears with mucus production around the paraffin showed an increased number of glands and secreting epithelial cells, much as in glue ears. Residual or recurrent cholesteatoma appeared in only 2.4%, which is attributed to resection of the posterior canal wall in cases of cholesteatoma, as contrasted with the intact canal wall technique.