Tympanoplasty: Staging the operation

Abstract The goals of tympanoplasty are two: elimination of disease and permanent restoration of hearing. A planned two‐stage tympanoplasty is recommended to accomplish these goals in cases with extensive middle ear mucous membrane disease, in cases with absence of all ossicular tissue and in cases in which there is uncertainty regarding the eradication of cholesteatoma. The most satisfactory technique for restoring hearing in cases without ossicular tissue is a cartilage strut to the stapes footplate. To avoid post‐operative sensori‐neural impairment the surgeon should not open the labyrinth while removing middle ear and mastoid disease. Serious consideration should be given to mastoid re‐exploration for residual disease in all cases in which a closed technique is used for mastoid cholesteatoma. The. otologist must have a thorough knowledge of principles of tympanoplasty and must execute the surgical techniques precisely. By so doing, he should be able to restore useful hearing to the majority of his patients.