An endoscopic method of tympanic membrane fluorescein angiography

Fluorescein angiography is a recently developed method of studying the tympanic membrane's dynamic vasculature. Our preliminary studies using an ophthalmic fundus camera and aural speculum did not always permit visualization of the entire tympanic membrane, and the electronic flash unit used in our initial studies did not cycle fast enough to visualize effectively the rapid arterial phase of blood flow. In this report, we describe an endoscopic method of tympanic membrane fluorescein angiography that uses a continuous xenon light source. A representative angiogram from a normal subject is described. The mallear artery apparently is the major blood supply to the posterior half of the tympanic membrane, which is consistently better perfused than the anterior half. Branches from the annular ring of blood vessels supply the anterior half of the tympanic membrane. Preliminary studies of two temporalis fascia tympanoplasty patients indicate that the graft becomes revascularized 2 to 4 weeks after surgery and that posterior grafts may revascularize earlier than anterior grafts.