Question

Combined approach tympanoplasty.

Hint:

The combined approach tympanoplasty is ideal for cases where traditional transcanal surgery would not provide sufficient access or visibility to treat the disease.

Answer 1

Step 1: Definition of Combined Approach Tympanoplasty.
Combined approach tympanoplasty is a surgical procedure used to treat chronic otitis media with associated cholesteatomas or perforations in the tympanic membrane. The technique combines both the transcanal and retroauricular (postauricular) approaches to the middle ear. This method allows for better access to the middle ear structures and is typically employed when the disease affects both the ear canal and the mastoid cavity.

Step 2: Indications for Combined Approach Tympanoplasty.
The combined approach is typically used when:
- There is a cholesteatoma or chronic suppurative otitis media that involves the middle ear and mastoid.
- The ear canal alone is insufficient for reaching the affected area, especially in complex cases.
- It is required when there are extensive perforations of the tympanic membrane or ossicular damage that cannot be addressed through the transcanal approach alone.

Step 3: Surgical Procedure.
The combined approach typically involves:
1. Postauricular incision: A small incision behind the ear is made to access the mastoid.
2. Mastoidectomy: Removal of any disease or infected tissue in the mastoid air cells.
3. Tympanoplasty: The tympanic membrane is reconstructed using grafts, and ossicular reconstruction may also be performed if there is ossicular damage.
4. Transcanal approach: The ear canal is used for visualization and placement of grafts or prostheses.

Step 4: Postoperative Care.
Following surgery, the patient may require:
- Antibiotics to prevent infection.
- Regular follow-up to monitor healing and prevent recurrence of infection.
- Hearing tests to assess the effectiveness of the surgery.

Step 5: Conclusion.
Combined approach tympanoplasty is an effective treatment for complicated ear conditions that require both mastoid and ear canal access. It is particularly useful for treating diseases such as cholesteatomas and chronic otitis media.