THE possibility of restoration of hearing in cases requiring a radical mastoidectomy is worthy of consideration when the eustachian tube remains patent, and there is bilateral conductive deafness. The removal of severe middle ear disease requires complete reepithelialization of the middle ear, the reconstruction of a new eardrum, and the reconstruction of a new conductive mechanism. Spontaneous reepithelialization of the middle ear occurs around Rambo's1-4 paraffin implant; such spontaneous reepithelialization from the mucosal-lined tympanic orifice of the patent eustachian tube has given beautiful mucosal-lined middle ears as compared to disappointment with epithelial grafts to recreate a middle ear cavity. The reconstruction of the new eardrum, with a sandwich graft with an internal layer of temporal fascia and external layer of canal skin, has been almost uniformly successful, through a double coverage to all margins and the added internal vascularity preventing delayed central necrosis. This almost uniform success
FARRIOR JB. Total Tympanoplasty Type V: Eustachian Tube Patency in Tympanoplasty. Arch Otolaryngol. 1965;81(4):398–409. doi:10.1001/archotol.1965.00750050409015
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