THE PROBLEM of middle ear reconstruction in cases where malleus, incus, and the stapes superstructure have been destroyed by disease involves the primary difficulty that, if there is no structure between ear drum and footplate of the stapes, there may be up to 50 db hearing loss. Therefore, to restore hearing, the surgeon must introduce a prosthesis of some foreign material or reconstruct a columella from autonomous tissues. With a plastic or metal prosthesis there are many difficulties which follow this type of reconstruction. There may be extrusion of strut, which at times will be followed by suppuration. Additional hearing loss may also ensue. This hearing loss may be due either to simply the loss of the prosthesis, or scarring following extrusion. At times, scar tissue will form around a nonextruded strut and immobilize the footplate, thus resulting in hearing loss. The use of flared polyethylene strut from drum graft
SIEDENTOP KH, BROWN RC. Type III—Polyethylene Columella Tympanoplasty: Long-Range Review of 28 Cases. Arch Otolaryngol. 1966;83(6):560–565. doi:10.1001/archotol.1966.00760020562012
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