The frequency of ossicular chain disease in chronic otitis media often compels the otologist—if the damage is significant—to sacrifice the incus and malleus and bring the stapes in direct contact with the neotympanic membrane (Tympanoplasty Type 3). The importance of this group is emphasized by Wullstein, who reports 490 tympanoplasties of Type 3 in a series of 1,400 tympanoplasties, i.e., 35%.7
The decision to sacrifice the ossicular chain is strongly influenced by the fact that its lever amplification is in the order of 1.31,8 and its loss should cause diminution of hearing of 2 to 5 db. only. Unfortunately, theory and practice do not always coincide.
Wullstein reported as "excellent results" in Type 3 tympanoplasties, a postoperative air-bone gap of up to 15 db. which was obtained only in 37% of his patients.7 Bruce Proctor reported a 30 db. air-bone gap in 66% of his tympanoplasties, the
RUBINSTEIN M, SADE J, KORINE E. Malleolostapedial Transposition in Middle Ear Surgery. Arch Otolaryngol. 1962;76(4):323–328. doi:10.1001/archotol.1962.00740050333007
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