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We come now to the cases in which we have to proceed to a reconstruction without the benefit of an ossicular chain or a substitute chain with sound protection only. For example, we make our control of the ear to determine the situation and find no remnant of the stapes, only an open oval window niche. The incus is gone too, and the problem is whether we should try to use an artificial stapes. Well, there are two questions to be answered. First, what is in the oval window niche? If there is an atrophic drum, adherent to the surface, it must be removed. If we do so, bare bone is left and again there is the difficulty of having no mucosa on the bony surface.
In another case, we may find part of one crus present but the rest missing, with a chronic osteitis of the remainder of the
WULLSTEIN H. Techniques of Tympanoplasty IV and V. AMA Arch Otolaryngol. 1960;71(3):451–453. doi:10.1001/archotol.1960.03770030093019
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