Four years have elapsed since the introduction of the concept of connective tissue grafting in tympanoplasty. During this time, experience has been gained with the use of vein as a graft material in over 1,500 operations. In addition, prosthetic techniques of stapes surgery have been modified and applied to tympanoplasty in an attempt to achieve more normal reconstruction of the hearing mechanism.
The idea of tissue grafting is to replace the missing fibrous elements of the tympanic membrane and to allow the normal epidermis and mucosa to regenerate over the graft. This provides obvious benefits over skin grafting and allows the drum to assume its normal anatomical appearance. The drum, so reconstructed, is found to have marked resistance to breakdown from infection or trauma.
The surgical procedure is divided into several basic and distinct stages.A.—If vein is used, it should be removed first to allow time for