Surgical treatment of chronic middle ear disease. 1. Myringoplasty and tympanoplasty.

Results of myringoplasty or tympanoplasty were evaluated in 225 ears followed for at least one year after surgery. Repair of the tympanic membrane with an underlay connective tissue graft (fascia in 90%) was successful in 97% of the ears. One late perforation developed 3 years postoperatively. The average postoperative air-bone gap was 4.8 dB in 88 cases of myringoplasty, the series including three ears with a rigid footplate. Rigid incus and malleus should not be mobilized but subjected to resection and reconstruction. Poor tubal function caused adhesive changes in one ear (1%). In tympanoplasty the average postoperative air-bone gap was 11.3 dB in 100 ears with stapes present and 20.6 dB in 36 ears with only the footplate remaining. Of the 137 tympanoplasty ears, 10 (7%) showed prominent adhesive changes. In 36 ears with cholesteatoma there was one recurrence 3 years later (3%). An air-bone gap of less than 20 dB was postoperatively noted in 94% of the ears undergoing myringoplasty and in 69% of the ears undergoing tympanoplasty.