Columellar tympanoplasty

This article discusses the problem that ossicular reconstruction presents when the malleus handle has been destroyed and a columella must be used. The technical problems and failures of the past twenty-five years are exposed in an effort to glean the lessons of this experience. A comparison of three types of columella currently used--bone, ceramic, and polyethylene--is presented. Since there have been disadvantages and excessive failure rates with each type of columella, other techniques have been attempted and are described. Many of the questions posed by the efforts to develop adequate solutions to the problems of columellar tympanoplasty are restated here in the hope that cooperative research and development between surgeon and manufacturer will continue and prosper.