Healing has been unreliable and the hearing results often disappointing with the early methods of tympanoplasty because of the unphysiological conditions existing after the creation of an open mastoid cavity. Growing dissatisfaction with this situation has led to a more conservative type of operation which preserves the anatomy of the middle ear cleft as far as possible, while at the same time removing the diseased tissue. The variety of this operation which I have called combined-approach tympanoplasty basically consists of preserving the bony meatal wall with the bony annulus so that the position of the drum and the depth of the middle ear space are maintained. This allows the construction of a sound transformer mechanism in the most advantageous environment. The principles of this operation are: (1) complete eradication of the disease, (2) avoidance of a postoperative mastoidectomy cavity, and (3) re-establishment of middle ear function.
The operation commences with
Smyth G. Combined Approach Tympanoplasty. Arch Otolaryngol. 1969;89(2):250–251. doi:10.1001/archotol.1969.00770020252007
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