XXXII Wherry Memorial Lecture. The ear surgeon of tomorrow. Tympanomastoidectomy techniques and classification

The ear surgery of the past 40 years (1936-1976) has been reviewed to demonstrate how this has influenced the development of modern microsurgery and the ear surgery of the future. The ear surgeon of tomorrow must have complete knowledge of the surgical anatomy and surgical pathology of the temporal bone, that pathology which has been produced by my generation of ear surgeons, and all techniques of all surgeons, for there is no single approach to surgery of the temporal bone. Only with complete and total knowledge of the temporal bone obtained by personal dissection can the surgeon succeed in the first operation. In unsheltered private practice, the patient will rarely give the surgeon a second chance. Residual postoperative cholesteatoma is divided into two types, encapsulated and exfoliative. In carcinoma of the external auditory canal, parotidectomy is advocated in continuity with the block resection of the external auditory canal. The classification of tympanoplasty is presented. Fenestration of the horizontal semicircular canal remains the operation of choice in bilateral congenital conductive deafness with stenosis of the external auditory canal, particularly in adult Treacher Collins syndrome. The evolution of the stapes techniques is presented with a view toward the diagnosis of future complications, and the postauricular transcanal approach is recommended for the removal of glomus tumors in the hypotympanum and removal of the jugular bulb.