THE CLASSICAL tympanoplasty type 4 performed in the absence of incus, malleus, and superstructure of the stapes has been a source of frustrating experience for many aural surgeons. Tympanoplasty type 4 has been successful in obtaining serviceable hearing with a long follow-up in not more than 30% of the cases in my experience. Disregarding the problems of obstructed eustachian tube and of recurrence of cholesteatoma, the reasons for frequent failures are (1) the shallowness of the middle ear aircleft under the graft, which is used to make a protective shield over the round window; (2) the frequent obliteration of the small tympanic cavity by adhesions; and (3) the frequently uncontrollable extension of the graft from the promontory over the footplate of the stapes during the healing process.
There has been a growing tendency to avoid tympanoplasty type 4 whenever possible in recent years. Sheehy and House1,2 reported poor
WALTNER JG. Dumbbell Tympanoplasty: A Substitute for Tympanoplasty Type 4. Arch Otolaryngol. 1966;83(4):339–342. doi:10.1001/archotol.1966.00760020341010
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