[The treatment of chronic adhesive otitis by tympanoplasty and active self-insufflation according to valsalva (author's transl)].

More than one year after tympanoplasty 85 to 95% of the followed up middle ears are aerated. The percentage depends on the degree of the preoperative adhesive process. We see the reason of this surprising success on the one hand in some special steps during operation (consequent silastic sheeting, preservation of the posterior bony canal with a deep middle ear cleft, visualisation of the tympanic orifice of the tube, widening of the natural connection between tympanon and mastoid without opening the chorda-facial-angle, some times mastoidectomy), on the other hand in a consequent postoperative follow up together with the surgeon until the ear is surely aerated controlled by self-insufflation (Valsalva). Therefore a preoperative tubal dysfunction is no contraindication for tympanoplasty: all ears should be operated. Because of the good results in hearing after just one operation, we try to rebuild the ossicular chain during the first intervention to avoid as often as possible a staged surgery.