Posterior meatal wall reconstruction in tympanoplasty

Area of Science:

• Otolaryngology
• Surgical Innovation
• Otology

Background:

• Chronic otitis media (COM) presents significant challenges in management, often requiring complex surgical interventions.
• Severe COM cases necessitate advanced techniques to address middle ear pathology and preserve/restore function.
• The posterior meatal wall plays a crucial role in middle ear dynamics and surgical access.

Observation:

• A novel operative method involving posterior meatal wall removal and reconstruction was applied to 41 severe chronic otitis media cases.
• Reconstruction utilized autograft bone or homograft cartilage following middle ear cleansing and ossiculoplasty.
• Surgical field visualization of the middle ear cavity was enhanced, with no observed graft rejection.

Findings:

• All treated ears achieved a dry state at an average 28-month follow-up.
• Cholesteatoma recurrence was noted in 18% of cases.
• Speech Reception Threshold (SRT) improved by 5-30 dB in 78% of patients; 21% experienced a slight deterioration (0-10 dB).

Implications:

• This surgical approach offers a viable solution for achieving dry middle ears in severe chronic otitis media.
• The technique demonstrates potential for hearing improvement in a majority of patients undergoing treatment.
• Further research may explore strategies to minimize cholesteatoma recurrence rates following this reconstructive method.