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We present in this video our innovative approach to mild to moderately sized perforations in the setting of chronic eustachian tube dysfunction with push through myringoplasty using tragal cartilage graft with primary T-tube. There was improvement in conductive hearing loss while allowing for stable middle ear ventilation with this technique.
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
None
None
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