["Fuldaer ventilation surgery"--a surgical concept in severe ventilation disorders of the middle ear]

This report presents the long-term results of a special surgical technique in cases of persistent severe dysfunction of the Eustachian tube.

We performed this operation on 16 patients (18 ears) between 1982 and 1997. Almost all patients had undergone previous surgery. This included myringotomies and tube insertions, adenoidectomies, tonsillectomies, myringoplasties and mastoidectomies, sinus surgeries, and an operation on a cleft palate. The concept developed by one coauthor (Draf) combines different methods to improve ventilation of the middle ear and protect the eardrum against partial vacuum. The concept combines mastoidectomy, posterior tympanotomy, and removal of the incus and the head of the malleus with an interposition of the incus. The tympanic membrane is then stabilized with a cartilage-perichondrium graft, and a tube is placed leading from the tympanic cavity to the nose (Wright-tube). A T tube may also be used. The procedure was varied slightly on occasion depending on intraoperative findings.

Thirteen patients (15 ears) were available for audiometry at a minimum of 5 months after surgery until 14 years (mean duration of 6.2 years). We compared preoperative and postoperative air-bone gaps. They were measured for the three speech frequencies (500, 1000, and 2000 Hz) at 5 dB intervals. The average preoperative air-bone gap was 25.7 dB versus 18.2 dB postoperatively. This represents an improvement of 7.5 dB. Seven of fifteen ears required revision. Six ears required one revision procedure each (three for cholesteatoma, one for myringitis, one for discharge due to a narrow external auditory meatus, and one for mastoiditis). Another patient required three revision procedures (one for mastoiditis and the other two for cholesteatoma).

This concept can help prevent cholesteatoma and improve hearing in more than 50 per cent of severe cases of dysfunction of the Eustachian tube.