Cartilage push through myringoplasty with T-tube

This procedure represents a push through cartilage myringoplasty with primary T-tube for treatment of mixed hearing loss for patients with chronic eustachian tube dysfunction. This is a reasonable management of small to moderately sized central perforations of the tympanic membrane.

Treatment of mixed hearing loss for patients with chronic eustachian tube dysfunction

Large tympanic membrane perforations
Ossicular discontinuity
Concern for cholesteatoma

Haag microscope
Round knife
Sickle knife
Myringotomy set
Soft tissue set

Patient's head remained at anesthesia.
Microscope base was placed across from patient.
Towel out of ear without formal drape
Betadine pain preparation solution

Audiogram to establish degree of conductive hearing loss
CT temporal bone if concerns for cholesteatoma in chronically draining ear or ossicular fixation/discontinuity in large conductive hearing loss

Anatomy of the tympanic membrane
Identification of umbo and annulus
Avoiding manipulation of ossicular chain

Residual perforation
Graft infection or loss
Tube otorrhea

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