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Myringotomy

Myringotomy. Making an incision in the TM May put a VT Not to be confused with Tympanotomy  Opening the middle ear. Indications of Myringotomy. Ac Otitis Media with bulging TM Incompletely resolved AOM Complicated AOM OME

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Myringotomy

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  1. Myringotomy • Making an incision in the TM May put a VT Not to be confused with Tympanotomy Opening the middle ear

  2. Indications of Myringotomy • Ac Otitis Media with bulging TM • Incompletely resolved AOM • Complicated AOM • OME • ETD  Ret pockets / pilots / unresolving or recurreni Aero otitis

  3. Complications • Injury to icudostapedial joint • Injury to jugular bulb if it is high / bone is dehiscent • Infection

  4. Incisions • Transcanal / permeatal • Endaural • Postaural

  5. Treatment in Tubotympanic disease • To make the ear dry • To restore hearing

  6. Tympanoplasty • To reconstruct TM & middle ear mechanism • Myringoplasty: To reconstruct TM

  7. Contraindications • Active discharge from the ear • Nasal Allergy • Otitis Externa • Other ear has No hearing • Children below 12 Yrs of age

  8. Graft Materials • Temporalis fascia • Perichondrium • Tragal cartilage • Vein

  9. Types of tympanoplasty

  10. Myringoplasty (Type 1)

  11. Complications • Residual perforation • Lateralization of the graft • Infection & graft failure • Trauma to ossicles, inner ear & 7th N • Cholesteatoma formation • Blunting of ant sulcus

  12. Mastoidectomy • An operation to eradicate the disease from mastoid cells &/ middle ear. • Can be combined with Tympanoplasty • Cortical Mastoidectomy • Radical Mastoidectomy • Modified Radical Mastoidectomy

  13. Cortical Mastoidectomy • All the mastoid air cell are exentrated Middle ear & Posterior meatal wall are preserved INDICATIONS • Acute coalescent mastoiditis • Incompletly resolved ASOM • Approach to other areas eg Endolymph, Int auditory meatus

  14. Complications • 7th N paralysis/paresis • Vertigo • Hemorrhage • Infection & wound breakdown

  15. TREATMENT of Atticoantral disease Aims : • To render the ear safe • To eradicate the infection • To restore hearing as far as possible Mainstay of treatment is surgical except in small retraction pockets where suction clearance of debris & granulations followed by antibiotics ear drops may control the disease ( Cover Ps. Staph & Anaerobes )

  16. Modified Radical & Radical Mastoidectomy • Radical Mastoidectomy: To eradicate the disease from the mastoid & Middle ear • Posterior Meatal wall is Removed to make mastoid & middle ear a single cavity • TM remanant & All the ossicles except Footplte of stapes are removed • No attempt to Reconstruct

  17. Modified Radical Mastoidectomy • Limited Cholesteatoma only in Attic & Mastoid antrum • Posterior meatal wall is removed • Remanants of TM & Ossicles Preserved • Hearing mechanism Reconstructed at same or later

  18. Atticotomy

  19. Stapedotomy • In Otosclerosis • To make a hole in the Stapes footplate & put a prosthesis between Stapes & Incus

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