Regenerated middle ear mucosa after tympanoplasty. Part II. Scanning electron microscopy

The ultrastructural appearance of the regenerated middle ear epithelium, found at the second operation of staged ICWT with mastoidectomy, has been investigated herein with the scanning electron microscope. The regenerated epithelium consists of flat nonciliated cells, "elevated" nonciliated cells with microvilli, and ciliated cells. Secretory material is present on the surface of the "elevated" nonciliated cells surrounding the ciliated ones. Regeneration of the mucosa occurs following precise topographic differences that mimic the distribution of epithelial cells in the normal middle ear. It is confirmed that a morphologically normal middle ear epithelium regenerates to cover all denuded bone surfaces within 12 months--after first stage ICWT with mastoidectomy--when silicone rubber sheeting has been used to maintain an aerated middle ear and mastoid space.