Index. Index. Note: page numbers in italics refer to figures and tables

Transcription

1 383 Note: page numbers in italics refer to figures and tables A air bone gap closure 115, 116 atretic ear surgery 148 FTT 118, 120 incus interposition 116, 117 replacement with stapedotomy 274 incus-stapedotomy 286 malleo-stapedotomy 117, 284, 286, 352, 367 mastoido-epitympanectomy 341 neomalleus with stapedotomy 121, 122 Spandrel II 118, 119, 121, 122 stapedectomy 278, stapedotomy 278, with incus replacement 274 neomalleus with 121, 122 revision 360 total with Spandrel or FTT 274 tympanoplasty type III 122, 123 anesthesia see general anesthesia; local anesthesia annular ligament 281 antibiotics postoperative 4 preoperative 3 transcanal approach 15 antrostomy, middle ear transducer device 218 antrotomy 47 cholesteatoma removal 177 surgical steps surgical technique 37 with temporary transmastoid drain 32 antrum mastoidectomy 161 size 301 transmastoid drainage 38 attic see epitympanum (attic) atticotomy see antrotomy; epitympanotomy audiometry Fisch titanium total prosthesis 318, 319 malleo-stapedotomy 367 ossiculoplasty 318, 319, 321 revision stapedotomy aural atresia, congenital , 149 anatomy 139, 140 approach 139 bilateral 139, 218, 220 bone-anchored hearing aid 218, 220 definition 139 HRCT , 370 indications for surgery 139 surgery 140, , 148, 149 combination with plastic reconstruction of external canal 146, results 148 unilateral 139 auricle, plastic reconstruction for malformation 139 auriculotemporal nerve, auricular branch block 5 B barotrauma, incus movements 223 bipolar forceps 236, 237 bone destruction, HRCT 309, 310, 334, bone anchored hearing aid (BAHA) congenital aural atresia 330 implantation , 220 instrumentation 220 results 218 burrs C caliper rod 255 canal wall conchal cartilage for posterior wall reconstruction 169 intact in tympanomastoidectomy 156 posterosuperior reconstruction , , 113 reinforcement 124 removal 152 re-epithelization of anterior 114 temporary resection 158 canal wall down 152, 157 canalplasty 46 anteroinferior 172 anterosuperior 227, 229, 239 ceruminal impaction and otosclerosis 329 endaural approach 282, 284 malleo-stapedotomy 282 otosclerosis 366 atretic ear 142, 147 cholesteatoma removal 176, 182, 203 with tympanoplasty 160 definition 2, 8 for exostosis 132, endaural 325 extended 182 incus-stapedotomy 227, inferior trough technique insufficient 43 malleo-stapedotomy 239 meatal skin flap 17 with meatoplasty 39, 42, 45 otitis externa obliterans 136, , 326 retroauricular approach 10, 17, 24, 24 25, 40 stapes surgery 289 tympanic sulcus 29 carotid artery, dehiscent 342 cartilage disk Fisch titanium total prosthesis 125, 320, 321 harvesting/preparation for FTT 83 cerebrospinal fluid leaks 214, 217 intraoperative and cochlear implants 347 cerumen retention 132 ceruminal impaction HRCT , 329 stapes surgery complication 364 chair, surgeon s 378 children bone anchored hearing aid 216, 218, 220

2 384 cerebrospinal fluid leaks 217 cholesteatoma 152, 153 postoperative cavity problems 201 surgical results 200 cochlear implant 213 congenital aural atresia surgery 139 open cavity postoperative care 219 pneumococcal vaccination 213 cholesteatoma 124, acquired , 155, 203 diagnosis 369 otitis media with marginal perforation 334 surgical treatment anterior tympanomeatal 43 chronic draining ears 214 classification , 155 closed cavity 159, 200, 203 closed tympanomastoidectomy 156 congenital 152 conservative treatment detachment from epitympanum wall 166 diagnosis 309, 310 dry 334, 369 elevation from supralabyrinthine/ supratubal recesses 180 fistula test 2 HRCT 310 iatrogenic 154 immigration theory 153, 154 inclusion 44 invasion intratympanic extent 177 routes 155 mastoido-epitympanectomy 152, 310 matrix destruction of bone 338 matrix removal from round window from semicircular canal 337, 339, 340 open cavity 159, 200, 203 correct exteriorization 190 inadequate exteriorization 201, 202 meatoplasty 196, packing 191, 192 re-epithelialization 204 revision surgery 201, ossiculoplasty 310 preoperative scan 313 otitis media with marginal perforation , 369 overlay grafting 188, pathogenesis pearls 44 perilymph fistula 337, 338, 339 postoperative cavity problems 201 primary acquired , 155 recurrent 154, 200, 335 removal from oval window 167, wound closure/packing 199 residual 44, 154, 200 retention 154, 206, 219 sac opening 164, 203 secondary acquired 152, 154, 155 size reduction 164 surgical approach choice 159 surgical results , 202, surgical techniques surgical treatment cholesterol granuloma 308, 311 chorda tympani atretic ear surgery 142 incus-stapedotomy 229, 230 mobilization 230 preservation 124 separation from malleus neck 243 titanium incus 54 chorda tensor fold 124 normal ears 102 removal 102, 103, 166, 168 cochlea endosteum 266 obliteration 214 ossification 370 otosclerosis , 352, 353 round window occlusion 353 otospongiosis stimulation 282 cochlear implant 207, , 219 antibiotic prophylaxis 213 chronic otitis media 347 electrode array and receiver/stimulator package 212, 219 cables 344 fixation 210 introduction in scala tympani 211 placement 346, 370 external speech processor 209 HRCT 342, , 370 introduction 210 meningitis 217 receiver implantation 346 receiver/stimulator package bed 209 fixation 212, 219 implantation 217 results 217 round window niche exposure 213 subtotal petrosectomy 214, 219, 345, temporal bone malformations testing by audio engineer 213 wound closure cochlear nerve aplasia 370 cochlear turns 266 cochleariform process 104, 264, 266 HRCT 326 identification 265 cochleostomy 211, 219 anterior promontorial 260, 262 cochlear implant and subtotal petrosectomy 214 directly guided 266 indirectly guided 264, 265 computed tomography, high-resolution (HRCT) 292 axial , , 305, bone destruction 309, 310, 334, cartilaginous external auditory canal 369 clinical importance 368 cochlear implant 342, , 370 congenital aural atresia , 370 conventional , 298, 298 coronal 305, exostosis 325 external otitis with otosclerosis 328 Fisch titanium total prosthesis , , 369 incus-stapedotomy 349, , 370 labyrinthine fistula 369 malleo-stapedotomy 349, , 370 mastoidectomy open cavity special applications 342, mastoido-epitympanectomy with partial obliteration

3 385 meatoplasty middle ear implants 348, 370 multiplanar reconstruction techniques 292, 298, myringoplasty 311, ossicular chain total reconstruction ossiculoplasty , 369 otitis externa obliterans 326 otitis media 309, 310, 369 otosclerosis , , , 328, 329, 349, pneumatization extent 299, 300 preoperative scans 331, 368 revision surgery for sensorineural hearing loss 286, 288 stapedotomy 370 stapes surgery inner ear hearing loss 361, technical aspects temporal bone evaluation , , 305, surgery titanium incus 315, , 369 titanium neomalleus with stapedotomy 324 titanium stapes prosthesis titanium total prosthesis tympanoplasty special applications concha perichondrium for posterosuperior canal wall reconstruction 107, 109 skin flaps 197, 198 conchal cartilage 124 exposure in meatoplasty 197 fenestra closure 273 posterior canal wall reconstruction 169 posterosuperior canal wall reconstruction 107, 109 removal of excess for meatoplasty 196 connective tissue fixation to wire connective-tissue prosthesis 250 pledgets 87, 88 stapedotomy opening 264 connective tissue graft harvesting for stapedotomy 250 harvesting/preparation 278 tympanomeatal flap repair underlay 278 cranial fossa dura, middle new tympanic sulcus formation 143 position 301 skeletonization 141, 142, 171, 172, 181 epitympanum exteriorization 194, 195, 203 insufficient 337 mastoido-epitympanectomy 341 crurotomy, incus-stapedotomy 234 crurotomy scissors 258 cubital vein, venous blood removal 236 D deafness stapes surgery 289 see also hearing loss digastric ridge skeletonization 172 drills drum lateralization 121 position 113 reinforcement , E ear speculum 14, 127 electrode round window see also cochlear implant, electrode electromyography (EMG), facial nerve monitoring 6, 139, 142 cholesteatoma removal 203 cochlear implant 209 epitympanectomy 165, 166 mastoidectomy 178, 179 endaural approach 11 myringoplasty 8, 9, 11 surgical steps 16 surgical technique 15 epitympanectomy 38, , attic chronic disease 154 exenteration 166 exposure 164 with tympanoplasty 171, results 124 epitympanic patency, water test 38, 47 epitympanotomy 38, 103 atretic ear 141, 147, 148 anterosuperior for congenital aural atresia 331 with tympanoplasty 160 epitympanum (attic) 102 anterior epitympanectomy 102 superior ventilation route 104 ventilation 102, 124 atretic ear repair congenital 139, 331 location 141, 146 chronic infection with granulation tissue 155 exenteration 337 exposure 164 exteriorization 194, 195, 337 HRCT 301, 303, 304 inflammatory reaction 154 lateral wall removal 103 middle ventilation route 104 with tympanoplasty 172 patency 38 posterior 104 retraction pockets 124 role 124 surgical anatomy 171 ventilation routes 104 Er:YAG laser floating footplate 256 footplate perforation 232, 245 ossicular chain mobilization 142 eustachian tube antrotomy 37, dysfunction 158 function 2, 7, 159 defective 217, 219 insufficient 44 Gelfilm sheeting 95 occlusion 348 sheeting 92, 105, , 188 temporary occlusion 32 tympanic ostium patency 368 exostosis HRCT 325 meatoplasty 42, 149 recurrence 135 removal 132, , 135 external auditory canal (EAC) absent aspiration 2, 7

4 386 atretic ear formation of new 142 plastic reconstruction 146, bony canal enlargement 39, 41 cartilaginous 357 HRCT 369 ceruminal impaction stapes surgery complication 364 closure for cochlear implant 346 debridement after surgery 149 enlargement 366 exostosis removal 132, exposure cholesteatoma removal retroauricular approach gauze application 4 preoperative 3 HRCT lateral stenosis 46 lumen obliteration 136 meatoplasty 39 narrow 327 obliteration 136, otitis externa stenosans 326 posterior wall electrode notch 130 restenosis prevention/risk 149 skin grafting 138, 147 widening 135 incus-stapedotomy 225 F facial nerve anomalous dehiscent 203, 257, 258, 259, 312 cholesteatoma 333, 334 otosclerosis 353, 358 stapedial otosclerosis 358 tympanic segment 352, 359 displacement function 139 geniculum 171 HRCT 301, 302, 303, 304, 308, 309 identification in atretic ear 143 labyrinthine 168, 171 mastoid segment 179, 218 pneumatic cell removal 341 pneumatic cells 301 skeletonization 209 monitoring 6, 7, 139, 142, 149 cholesteatoma removal 203 cochlear implant 209 epitympanectomy 165, 166 mastoidectomy 178, 179 pyramidal section 209 stapes prosthesis contact 259 tympanic segment 165, 168, 171 combined fascial underlay 187 combined grafting 186 dehiscence 352, 359 exposure 179 weakness 5 facial palsy, local anesthesia 4 facial ridge lowering 172, 179, 336 fallopian canal closed tympanomastoidectomy 168 mastoid segment HRCT 305, 306, 307, 314 ossiculoplasty 314 skeletonization , 219 with tympanoplasty 172 tympanic segment 179 HRCT 310 fenestrated ears, stapedotomy 272, Fisch endaural retractor 40, 47 canalplasty 134, 138 external auditory canal widening 225 Fisch footplate elevator 184 Fisch microraspatory 19, 21, 24, 134, 137 anomalous facial nerve 261 cholesteatoma removal 174 incus interposition 51 incus-stapedotomy 227 malleo-stapedotomy 239 tympanic facial nerve exposure 179 tympanomeatal flap elevation 97 Fisch titanium total prosthesis (FTT) 374, 375 air bone gap closure 118, 120 angulation error 322, 322 assembly 82 audiometry 318, 319 cartilage disk 125, 320, 321 harvesting/preparation 83 coupling shaft with cartilage pledgets 82 coupling with cartilage disk 82 coupling with foot and spike 82 failure 322, fixation 125 fixed footplate and malleus, closed cavity 69, 72 foot fixation to stapes footplate 82 with spike 80, 318 stabilization 65 with foot and spike and with cartilage disk head 80 adaptation to space 81 adaptation to tympanic membrane 81 rotation 66, 83 shaping 66 size 125 HRCT , , 369 multiplanar reconstruction incudomallear joint action reproduction length determination 66, 98, 125 L-shaped 118, 120, 125 mastoido-epitympanectomy with staged ossiculoplasty 314 mobile footplate closed cavity 79, 80, and malleus 55, 58 59, 66 open cavity 96, mobile stapes, closed cavity 76, 77 open cavity 319 ossicular chain total reconstruction ossiculoplasty 311, 312 perforation 66 positioning on footplate 66, 98 results 118, 120 shaft 80 coupling with cartilage pledgets 82 cutting 81 shoe with spike 98 size error 322, stabilization 66 stapedectomy fixed footplate, closed cavity 89 fixed stapes, open cavity 101 total 72 tympanosclerosis 276 stapedotomy in fenestrated ears 274 stapes only, closed cavity 75 surgical steps 66, surgical technique 66, 72 tragal cartilage 66 transportation 66, 82, 125 fistula test 2 floating mass transducer 215, 218

5 387 fluoride therapy, preoperative 352, 353 flying post-surgery 7 footplate elevator 70 FTT see Fisch titanium total prosthesis (FTT) G Gelfilm 15, 46 anterior fascial underlay 187 eustachian tube sheeting 92, 95, 105, first-stage tympanoplasty 186 infected ears 124 middle ear sheeting 92, 95, 105, shaping 105 sheeting 187 tubotympanic sheet 189 tympanoplasty 188 Gelfoam pledgets 3 adverse effects 46 atretic ear surgery wound closure 145 autograft ossicle 99 intratympanic 15, 16 anterosuperior perforation 32 oval window split-thickness skin graft 96 overlaid fascia 36, 94 perilymph fistula closure 272 removal 43 tympanoplasty type III 93 underlay graft 27, 28 wound packing 199 general anesthesia 4 patient position 3 stapes surgery 289 geniculate ganglion, HRCT 308 gold stapes prosthesis incorrect size Goode T-Grommet 128, 129 grafting technique anterosuperior fixation 33 placement of graft subtotal perforation 34 tympanic membrane 11 12, 16 retroauricular approach see also overlay; underlay grommets gusher 262, H hair shaving, preoperative 3 handpieces 376 hearing atretic ear surgery results 148 levels malleo-stapedotomy 284, 286 otosclerosis surgery 287 stapedectomy/stapedotomy 282, 283 unmeasurable preoperative 288 see also audiometry hearing aid see bone-anchored hearing aid (BAHA) hearing loss conductive 215, 220 mastoidectomy 320 missing stapes 262 neomalleus with stapedotomy 121 ossiculoplasty 311, 312 revision stapedotomy revision stapes surgery 287 cost 368 inner ear 361, malleus fixation 284 perilymph fistula 271 sensorineural 215, 217, 220, 289 cochloestomy risk 266 ossicular chain total reconstruction 318 revision surgery 286, 288 stapes surgery , 361, Henle s spine, large 325, 327 hyperacousis, disabling 364, 366 hypotympanum 104 resurfacing 219 sheeting 105, 189 I immigration theory 153, 154 incudomallear joint exposure 271 visualization in incus-stapedotomy 230 incudostapedial joint 233 disarticulation 46, 271 division 161, 290 separation 26, 234, 240, 248 obliterative otosclerosis 254 incus autograft introduction 99 modification 78 stabilization 99 erosion 270, 358 removal 328 exposure in atretic ear 142 fitting 51 fixation 233 anterior mallear ligament calcification 366 previously undetected 271 floating mass transducer fixation 218 intact and overlong prosthesis 269, 270 luxation 229, 230 removal 363 temporal bone fracture 315 malformed 139 removal 265 missing long process 50 mobility 233, 234, 235 modified 52 movement with barotrauma 223 obliterative otosclerosis 256 placement 78 prosthesis attachment 256 crimping , 252, 290 loop fixation 233 reconstruction 115 removal 50 atrophic 165 epitympanectomy 102, 103, malleo-stapedotomy 242 oval window obstruction 259 shaping 51 short 259, 260 stapes prosthesis crimping 252, 290 variable inclination of interposed 52 wire connective-tissue prosthesis crimping see also titanium incus incus interposition 38, 49, 49 54, 115, 116, 117, 124 air bone gap closure 116, 117 autograft 116 with autograft ossicle columella reconstruction 52 ossiculoplasty 315, surgical steps titanium incus 54 tympanomeatal flap 53 incus replacement with stapedectomy see malleo-stapedotomy incus-stapedotomy 224, air bone gap closure 286 canalplasty

6 388 anterosuperior 227 ceruminal impaction and otosclerosis 329 footplate perforation hemostasis 237 HRCT 349, , 370 otosclerosis prosthesis fixation 233 introduction length changes 235 length determination 230 storage 231 trimming results sealing of opening 236 surgical steps titanium stapes prosthesis , 281, 353, 354, transmeatal tympanomeatal flap repositioning wound closure/packing 237 inferior trough technique inner ear damage risk with stapes surgery 222, 289 malformations 214 instrumentation 7, see also named instruments J jugular bulb high 339, 341 pneumatic cells elimination 335 position 301 K Kaja drain 112 keratin retention 132, 135 Key raspatory 21, 23, 85 cholesteatoma removal 173 L labyrinthine fistula 203, 337, 338, 339 bone defect ossification 342 HRCT 369 prosthesis incorrect size 355 labyrinthitis cochlea obliteration 214 prevention 184 laser therapy footplate perforation 290 see also Er:YAG laser local anesthesia 4 canal injections 5 initial site 5 patient position 3 postauricular injection 5 stapes surgery 289 M magnetic resonance imaging (MRI) 370 malleable measuring rod 63, 67 mallear ligament, anterior 238 calcification 366 hyalinization 284 ossified 243 mallear process, anterior 243 fixation 326 malleolar fold, superior 103 malleo-stapedotomy 222, 238, air bone gap closure 117, 284, 286 anomalous facial nerve 261 audiometry 367 fenestrated ear 273 fixed footplate and malleus, closed cavity 69 functional repair of malleus/incus fixation 289 hearing levels 284, 286 HRCT 349, , 370 incus erosion 270 indirectly-guided cochloestomy 265 malleus handle 125 mobile footplate and malleus 55, in trauma 118 otosclerosis 284, , 367 oval window obstruction 259 prosthesis attachment 125 length determination 243, 244 results , 282, 284 revision stapedotomy 357 stapes fixation 284 surgical steps surgical technique 55, 238 titanium stapes prosthesis 244, 354, , tympanosclerosis 276 malleus atretic ear 142 debridement of tip 29 distance to footplate 56 fixation 233, 238 anterior mallear ligament calcification 366 hearing loss 284 otosclerosis 282 previously undetected 271 removal 328 graft placement lateral process 228, 229 malformed 139, 142, 149 mobility 233, 234, 235, 238, 239, 271 assessment 240 evaluation 282 overlaid fascia anchoring at tip 36 short process exposure 227, 229 stabilization in atretic ear 142 see also neomalleus with stapedotomy (NMS) malleus handle distance from stapes head 51, 52 exposure 56, 241 footplate distance 67 loop adaptation to malleus handle size 245 malleo-stapedotomy 125 mobility 243 movement 57 reconstruction 168 Spandrel head rotation 64 titanium incus 54 titanium stapes prosthesis adaptation to positions crimping 57, 247 loop adaptation 245 shaping 244 malleus head incus interposition 49 position 357 removal 166, 171, epitympanectomy 102, 103, malleus nipper 242, 243 mastoid exposure cholesteatoma removal 173 retroauricular approach 18 insufficient bone removal 339 obliterated 205, 206, 217 open cavity reconstruction 206 open cavity correct exteriorization 190 meatoplasty 196, packing 191, 192

7 389 reconstruction 205, 206, 217, 219 partial obliteration 337 pneumatization 308, 314, absent 344 cochlear implant 343 congenital aural atresia 330, 331 HRCT 326 mastoido-epitympanectomy pneumatized 203, 300 highly 190, 192, , 200 poorly sclerotic 159, 213, 300, 308 squamous epithelial ingrowth 162 ventilation 38, 200, 205, 206, 217, 219 mastoid cells, pneumatic 308 mastoid drain 38, 47 mastoid groove cochlear implant electrode fixation 210 drilling 219 mastoid plane exposure 161 mastoid process, malformed 139, 140 mastoid raspatory 193 mastoid tip exposure 178 removal 172, , 203 mastoidectomy 103, anterior 209 atretic ear 148 bone removal 162 incorrect 163 with tympanoplasty 160, cochlear implant procedure 209 cortical 152 facial ridge lowering 172, 179 HRCT indications 308 open cavity HRCT with tympanoplasty 170, open closed 158 radical 157 special applications , 342, surgical site after 164 mastoiditis, acute 203 mastoido-epitympanectomy 152 mastoid bone removal 339 open 157 bone work checklist 172 with staged ossiculoplasty 314 open with tympanoplasty 170, , , 217 bone work checklist 219 open cavity reconstruction 206 with ossiculoplasty 332 staged 314 with partial obliteration (METO) 332, , 342 reduced pneumatization 310, 332 revision follow-up skeletonization 334 with tympanoplasty closed 160, open 170, , , 206, 217, 219 radical 200 tympanosclerosis 274 meatal skin, poorly pneumatized mastoid 191 meatal skin flap 18 21, 22 alternative atretic ear surgery 149 canalplasty 17, 132, 133, otitis externa obliterans 137 retroauricular 40 cholesteatoma removal elevation 46 extended 226, 227 highly pneumatized mastoid 192 incus-stapedotomy placement 47 poorly pneumatized mastoid 190 repositioning 31, 36 meato-canalplasty external auricular canal cerumen impaction 327 retroauricular closed tympanoantrotomy 328 meatomastoid fistula 162, 163 meatoplasty canalplasty 39, 42, 45 for exostosis 132 for otitis externa obliterans 136 cholesteatoma removal 196, , 202 definition 2, 8 exostosis surgery 132, 149 external ear canal volume 219, 301 HRCT indications 45, 46 mastoido-epitympanectomy 196, , 202 open cavity 336, otitis externa obliterans surgery 149 scar tissue removal 136 surgical steps technique 47 ventilation 203 meatus anterior incision 134 external 42 meningitis cochlear implant 217 hearing loss 370 prevention 214 risk with CSF leaks with cochlear implant 347 mesotympanum resurfacing 219 sheeting 105, 189 micro-bipolar forceps 236, 237 microscope, operating 378 microtympanoplasty scissors 19, 20 middle ear aerated 300 atelectatic 311 defective mucosa 46, 186 exploration for cholesteatoma removal 177 FTT introduction 81 Gelfilm sheeting 95 inspection for closed mastoidoepitympanectomy with tympanoplasty 161 obliteration of cleft 345 pathological condition classification 293 sheeting 92, 105, , 186, 188 Spandrel introduction 71 ventilation 308 middle ear implants, active , HRCT 348, 370 indications results transducer insertion 348 middle ear prostheses see also named prostheses middle ear transducer (MET) device 215, 218 Mondini dysplasia 217 muscle relaxants 4, 7 musculoperiosteal flap

8 390 active middle ear implants 220 cochlear implant 208, 214, 219 wound closure subtotal petrosectomy 214 myosubcutaneous flap 204 healing 219 mastoid obliteration 217 mobilization 193 open cavity reconstruction 206 posterior cavity obliteration 194, 200 retrofacial/retrolabyrinthine cell obliteration 195 tissue preservation 219 myringoplasty ceruminal impaction 328 complications definition 2, 8 endaural approach 8, 9, 11 flying after 7 hearing results 45 HRCT 311, postoperative care 3 4 retroauricular approach 10, 11 surgical approaches 8, 9 11 temporal bone pneumatization 311, transcanal approach 8, 9, 11 myringotomy surgical steps 127 transcanal with ventilating tube N neomalleus lateralization 121 reconstruction 125 staged 276 titanium stapes prosthesis crimping 87 see also titanium neomalleus neomalleus with stapedotomy (NMS) 75, 84, 84 87, 88 air bone gap closure 121, 122 conductive hearing loss 121 fixed footplate, closed cavity 90 fixed stapes, open cavity 101 mobile footplate open cavity perforation 87 one-stage 88, 125 results 121, 122 space available 125 staged reconstruction for tympanosclerosis 276 stapedotomy phase 87 surgical steps surgical technique 84 titanium neomalleus 90, 324 incorporation 86 tragal perichondrium harvesting 85 NIM-2 see electromyography (EMG), facial nerve monitoring O occipital myosubcutaneous flap 204 mastoid obliteration 217 mobilization 193 open cavity reconstruction 206 posterior cavity obliteration 194, 200 retrofacial/retrolabyrinthine cell obliteration 195 ocular loop 378 open cavity 159, 200, 203 correct exteriorization 190 Fisch titanium total prosthesis 319 HRCT 310 inadequate exteriorization 201, 202 insufficient exteriorization 339, 340 meatoplasty 196, , 336, ossiculoplasty 312 packing 191, 192 postoperative care 219 reconstruction 205, , 217, 219 re-epithelialization 204 revision surgery 201, 202 small-volume self-cleansing 342 with tympanoplasty (OMET) 157 postoperative care 4 operating room equipment 378 operating table 378 ossicles defect classification 48 identification in atretic ear 147 malformed 139 reconstruction 203 see also incus; malleus; stapes ossicles, autograft fixed footplate and malleus, closed cavity 69, 72, 73 length determination 67 mobile footplate and malleus 55, 66, open cavity 98, 99 mobile stapes, closed cavity 77, 78 osseous fixation 66 ossicular chain failure 68 placement 67 shaping 67 stabilization 68, 99 ossicular chain cholesteatoma removal 177 coupling of active middle ear implant 220 mobility 234, 235 mobilization in atretic ear 142, 147 reconstruction 113, 116, 168 failure after 68 HRCT total ossicular columella 78 ossicular tissue condition ossiculoplasty air bone gap closure 115, 116 audiometry 318, 319, 321 autograft ossicles 67 68, 72, 73 basic situations 48 cholesteatoma 310 closed cavity 311 with tympanoplasty 168 definition 2 drum reinforcement , epitympanectomy , , 124 factors improving results Fisch titanium total prosthesis 66, 69 fixed footplate 75 closed cavity and malleus, closed cavity fixed stapes, open cavity 101 flying after 7 following mastoido-epitympanectomy 310 footplate and malleus HRCT , 369 limitations after 7 long-term results 116, 117 malleo-stapedotomy 55, malleus and footplate 48 malleus and stapes present 48 incus missing method selection 115 mobile footplate 75

9 391 closed cavity and malleus, closed cavity open cavity mobile stapes 75 closed cavity one-stage with mastoido-epitympanectomy 332 open cavity 312 ossicular tissue condition posterior canal wall reconstruction , postoperative scans 315 preoperative scans 313, results , , , 123, 124 sheeting of middle ear and eustachian tube 105, Spandrel II 58 59, 59 65, staged surgery 124, 369 staging 113, stapes only 48, closed cavity open cavity transmastoid drainage 112 see also Fisch titanium total prosthesis (FTT); incus interposition; neomalleus with stapedotomy (NMS); ossicles, autograft; Spandrel II otic capsule ossification 211 otospongiosis 351, 353 otitis externa chronic and meatoplasty 42 recurrent 132, stenosans 326 otitis externa obliterans canalplasty 136, HRCT 326 meatoplasty 42, 149 otitis media, chronic 45 bone atrophy 309, 310 with central perforation 369 cholesteatoma 155 chronic draining ears 214 cochlear implant 347 HRCT 309, 310, 369 malleo-stapedotomy with mobile footplate 118 marginal perforation with cholesteatoma , 369 bone destruction mastoido-epitympanectomy 152 ossiculoplasty preoperative scan 313 protympanum pneumatization 300 surgical procedure tympanic membrane adhesive retractions 311 otitis media, necrotizing 153 otology superspecialization 292 otosclerosis bilateral cochlear , 352 diagnosis 349, fenestral focus removal 273 hearing levels 287 HRCT , , , 328, 329, 349, incus-stapedotomy malleo-stapedotomy 284, , 367 malleus fixation 238, 282 obliterative 254, drilling 255 irrigation 255 prosthesis length determination 255 stapes surgery results 278 surgical site 254 titanium stapes prosthesis 255, 256 recurrent external otitis 328 revision surgery 287, stapedial , 358 stapes fixation 238, 272 otospongiosis cochlear otic capsule invasion 353 stapes footplate 359 oval window anomalous facial nerve 261 cholesteatoma removal 167, drainage 203 exposure in incus-stapedotomy 229 floating footplate extraction 257 HRCT 301, 302, 303, 304, 305, 306, 307 cholesteatoma diagnosis 310 myringoplasty 311, 312 open cavity indication 310 ossiculoplasty 313, 314 lateral displacement risk 289 membrane displacement 223 palpation 268 mucosa scraping 87, 88 perforation incus erosion 270 obliterative otosclerosis 255 revision stapes surgery 268 perichondrium covering 252 perilymph fistula 272 perilymph movement transmission 268 reobliteration 267, 285 skin grafting 96, 188 Spandrel 71 split-thickness skin graft 96 stapedectomy prosthesis fixation/sealing 252 sealing 250 tragal perichondrium covering 70, 73, 90 oval window niche bone perforation 263 exposure 76, 78, 97 autograft ossicle 99 HRCT in titanium incus interposition 315, 316 identifiable with missing stapes 262, matrix 342 narrow 257, , 351, 352, 357, 358 otospongiosis 350 perforation 263 closure 264 saucerization 289 scar formation minimization 113 stabilization 125 tragal cartilage 65 tympanosclerosis removal 275, 276 overlay 11 12, 12, 47 anchoring to malleus tip 36 complications 44 fixation 36 grafting 186, 188, lateral displacement 44 posterior 12 total 12, 25 total perforation 35, P pars tensa defect 155 patient, intraoperative position 3 perforation anteroinferior 27, 27 combined underlay graft anterosuperior 27, 28 retroauricular approach closure rate 45 draining 3, 7

10 392 dry 3, 7 exposure 14 intratympanic fixation 15 outfolding 14 overlay grafting 35, Silastic sheeting presence 125 subtotal 28 grafting 34 temporary closure 2 total and overlay grafting 35, traumatic 13 pericarotid cells, exenteration 348 perilymph lumbar drainage movement transmission 268 outflow perilymph fistula 179, 270, 337, 338, 339, 340 after stapes surgery closure 272 following stapedectomy 271, re-ossification 341, 342 repair 184 periosteal flap retroauricular approach 17 see also retroauricular periosteal flap periosteum, parietosquamous 219 elevation 208 petrosectomy, subtotal 211, 214, 345 cochlear implant 219, 345, CSF leaks 217, 347 pericarotid cell exenteration 348 platinum Teflon prosthesis see Teflon platinum piston pneumatization HRCT 299, 300 mastoid 308, 314, absent 344 cochlear implant 343 congenital aural atresia 330, 331 HRCT 326 mastoido-epitympanectomy protympanum 300 reduced and mastoido-epitympanectomy 310, 332 temporal bone 2, 159 extent 299, 300 HRCT evaluation 301, 305 myringoplasty 311, tympanic cavity 330 tympanomastoidectomy 310 tympanoplasty 308 tympano-zygomatic bones 300 pneumococcal vaccination, children with cochlear implant 213 postoperative care 3 4 premedication for anesthesia 4 preoperative care/treatment 2 3 protympanum air in 308, HRCT 301, 302, 303, 304, 305, 306, 307, 308, 309 myringoplasty 311, 312 titanium incus interposition 316 matrix invasion 342 pneumatization 300 R radiology see computed tomography, high-resolution (HRCT) reperforation, anterior 43 retraction pocket 44 retroauricular approach 8, 11 canalplasty 10, 24, 24 25, 40 meatal skin flap 18 21, myringoplasty 10, 11 periosteal flap 17 surgical steps surgical technique 17 tympanic bone exposure 21 22, 23 tympanic membrane grafting technique 25 retroauricular periosteal flap 17 positioning 124 transmastoid drainage 112 retroauricular retractor, articulated 18, 174 retrofacial cells, pneumatic 301 retrofacial cells, exenteration/exteriorization 172, 180 incomplete 201, 202 retrolabyrinthine cells elimination 334 exenteration/exteriorization 172, 180, 335 incomplete 201, 202 pneumatic 301 round window drainage 203 electrode exposure 130 HRCT 301, 302, 303, 304, 305, 306, 307 ossiculoplasty 313 titanium incus interposition 315 membrane obliteration 343 occlusion by cochlear otosclerosis 353 perilymph movement transmission 268 reflex absence 268 sheeting 105 temporary access 129, round window niche 104 exposure for cochlear implant 213 S scala tympani 211 scala vestibuli cochlear implant electrode placement 211 cochleostomy 264, 265, 266 fenestration 264, 265 scar tissue, meatoplasty 136 scutum, erosion 333, 334 semicircular canal bone destruction 338 cholesteatoma matrix removal 337, 339, 340 fenestra 272, 273 fistula 165 labyrinthine 337, 338, 339 posterior 179 sclerotic bone surround 334 superior and HRCT 301, 302, 303 Shea vein press 70 sheeting see Gelfilm; Silastic sheet Shrapnell s membrane injury 155 integrity in stapedotomy 237 perforation 155 preservation 137 retraction 102 sigmoid sinus exposure 337 position 301 skeletonization 172 Silastic sheet 124 anterior fascial underlay 187 with tympanoplasty 169 eustachian tube sheeting 92, 105, first-stage tympanoplasty 186 foreign body reaction 125 FTT 319, 320

11 393 middle ear sheeting 92, 105, shaping 105, staging 113, 114 tubotympanic 189 tympanoplasty 188 sinus tympani, exposure 166 skeletonization technique 24 skin flap anchoring sutures 143 atretic ear surgery 143 conchal 197, 198 fixation 198 meatoplasty 40, 41 skin graft, full-thickness 188 skin graft, split-thickness anchoring 145, 147, 149 atretic ear surgery 144, 147, 149 external auditory canal grafting 138, 147 oval window 96 overlay 144, 145 Soundtec device 215 Spandrel II air removal from casing air bone gap closure 118, 119, 121, 122 assembly 62 casing trimming 61, 71 extrusion rate 118, 120 fixed footplate and malleus, closed cavity 69, head 59 angulation 62 reduction 71 rotation 64, 72, 77, 79, 90 shaping 63 transportation 71 incudomallear joint action reproduction length determination 60, 63 mobile footplate closed cavity 79 and malleus 55, 58 59, open cavity 96 mobile stapes, closed cavity 76, positioning 72, 77, 79 on footplate 64 prosthesis 59 results 118, 119, 120 shaft with spike 90 trimming 125 shoe 62 assembly 76 fitting 76, 77 perforation 61 positioning 64 size adjustment 125 stabilization 64, 65, 79 sound-collecting/-conducting behavior 58 and stapedectomy fixed footplate, closed cavity 89, 90 fixed stapes, open cavity 101 total 274 for tympanosclerosis 276 stapes only, closed cavity 75 surgical steps transportation 63 wire core cutting 61, 71 speech processor, external 216 stapedectomy 222, , 248, bilateral 289 fistula formation 285 with FTT 276 hearing level 282, 283 inner ear damage risk 222 mobile footplate 124, 125 open cavity 101 oval window membrane displacement 223 perilymph fistula 271, prosthesis length determination 248 migration of shaft 267, migration risk 223 results 278, revision 267 failure , 287 with Spandrel II 276 surgical skill 289 surgical steps surgical technique 248 Teflon platinum piston 252 titanium stapes piston 252 total 70, 73, 90 with Spandrel II 274 wire-connective-tissue prosthesis 248, introduction 249 loop formation 251 migration 267 perilymph fistula removal 267 storage 251 stapedial otosclerosis , 358 stapedial tendon 184 cutting 248 stapedotomy 222, after perilymph fistula closure 272 air bone gap 115 fenestrated ears 272, hearing level 282, 283 HRCT 370 inner ear damage risk 222, 289 instruments 289 mallear mobility 238 missing stapes 263 mucosa scraping 290 narrow oval window niche 257, neomalleus with 75 obliterative otosclerosis 254 opening size 232 patient risks 264 prosthesis displaced 285 migration risk 223 results 278, unmeasurable preoperative hearing 288 revision 356, 357 audiometry failure , 287 otosclerosis safe area 231 sealing of opening 57, 87, 236, 247, 258, 289 missing stapes 264 obliterative otosclerosis 256 revision stapes surgery 268 short incus 259, 260 before stapedial arch removal 289 surgical skill 289 surgical technique 224, titanium neomalleus 324 see also incus-stapedotomy; malleo-stapedotomy; neomalleus with stapedotomy (NMS) stapedotomy measuring rod 56 stapes anomalous 263 cholesteatoma matrix removal 167 fixation 238, 272 malleo-stapedotomy 284 results 288 malformed 139 missing identifiable oval window niche 262, unidentifiable oval window niche 262, 264,

12 394 see also titanium stapes piston (TSP); titanium stapes prosthesis stapes arch cutting 167 intact 290 removal 113, 125, 184, , 254, 273 cochleostomy 265 malleo-stapedotomy 245 narrow oval window niche 257, 258 stapedectomy 249 tympanosclerosis 275 stapes footplate distance to drum 63 to malleus 56 floating , 290 extraction 257 FTT fixation 82 positioning 66, 98 incus-stapedotomy prosthesis 232 luxation 184 malleus handle distance 67 matrix 342 mobility 113 otospongiosis 359 perforation 248 malleo-stapedotomy 245 manual perforator use 290 of mobile 56, 87, 125 size 356 stapedotomy tympanosclerosis 275 removal 249 Spandrel positioning 64 stapedotomy opening 289, 352, 353 total stapedectomy 70, 90 see also stapedectomy stapes head distance from malleus handle 51, 52 magnet attachment 215 notch for titanium incus 54 stapes surgery complications 361, deafness 289 HRCT inner ear hearing loss 361, limitations after 7 perilymph fistula results 278, , , 283, , 287, 288 reversal of steps 289 revision failure causes , 287 hearing loss 287 sensorineural deafness skills 289 special applications tympanosclerosis 274, see also incus-stapedotomy; malleo-stapedotomy; stapedectomy; stapedotomy stylomastoid foramen 178 cochlear implant surgery 209 inferior tympanic ring lowering 182 mastoidectomy 179 skeletonization 172 stylomastoid periosteum 178 sublabyrinthine cell exenteration 336 supralabyrinthine cell exenteration 168, 195, 335 radical 181, 201, 202 supralabyrinthine recess 103, 171 cholesteatoma elevation 180 exenteration/exteriorization 168, 195, 335 radical 181, 201, 202 obliteration 195 supratubal cells, exenteration 168, 335 supratubal recess 103, 171, 336 cholesteatoma elevation 180 exenteration 168, 335 pneumatic cell remnants 337 radical exenteration/exteriorization 181 surgical approaches 8, 9 11 selection 11 see also named approaches T Teflon platinum piston 252, 259 audiometry 365, 366 erosion 357 incorrect placement 261 incorrect size incus erosion 270 incus-stapedotomy 281 migration 270, 355 perilymph fistula after stapes surgery prosthesis loop refixation 269 removal 362, replacement 270 stapedial otosclerosis 358 stapes surgery complications 362 results 278, temporal bone anatomic configuration 301 cavity filling 346 cochlear implant HRCT 342, drum reinforcement 110, fractures 214 titanium incus interposition 315 HRCT evaluation , , 305, key levels 301, , 305, malformations 214 cochlear implants microanatomy 368 pathologic changes 301 pneumatization 2, 159 extent 299, 300 HRCT evaluation 301, 305 myringoplasty 311, posterosuperior canal wall reconstruction 110, sclerotic 308 mastoido-epitympanectomy with partial obliteration 332 surgery temporal fascia anterior underlay 96, 169 posterior overlay 93 fixation 33, 189 graft fixation 30 harvesting/preparation 30, 143 intratympanic support 32 overlay grafts 94, 144, 145, 188, 189 poorly pneumatized mastoid 191 posterior overlay 93, 169 underlay 34, 187 combined 187 temporal line 146 temporal squama bone flap 110, exposure 178 tensor tympani muscle, semicanal 186, 187, 266 tensor tympani tendon 104, 124 cutting 316 incus interposition tensor chorda fold see chorda tensor fold

13 395 Thiersch grafts see skin graft, splitthickness titanium incus 53 54, 168, 374, 375 HRCT 315, , 369 inclination 316 interposition technique 54 otitis media with cholesteatoma 334 shaping 53 titanium neomalleus 324, 374, 375 titanium stapes piston (TSP) 55, , 374, 375 after perilymph fistula closure 272 anomalous facial nerve 261 fenestrated ear 273 final hearing level 282 hearing result 289 incus erosion 270 incus-stapedotomy indirectly-guided cochloestomy 265 length 289 loop 290 malleo-stapedotomy 244, 282 minimal bleeding induction 270 obliterative otosclerosis 256 revision stapes surgery 268 short incus 260 stapedectomy 252 vibrational energy 282 titanium stapes prosthesis (TPP) 56 adaptation to malleus handle positions after perilymph fistula closure 272 angled 259, 260 angulation 56 anomalous facial nerve 261 cochleostomy 265, 266 crimping to incus , 252, 290 to malleus handle 57, 247 to neomalleus 87 fenestrated ear 273 fixation, malleo-stapedotomy 246 HRCT incus erosion 270 incus-stapedotomy , 281, 353, 354, introduction 87, 246 length 56 loop adaptation to malleus handle 245 attachment 57 detachment 269 refixation 269 malleo-stapedotomy 244, 246, 354, , migration 268, 269, 270, 355 missing stapes 263 narrow oval window niche 258, 259 obliterative otosclerosis 255, 256 one-stage neomalleus with stapedotomy 88 overlong 269, 270 revision stapes surgery 268, 357 shaft bending 246 shaping 244 short incus 260 sizes 244 incorrect 355, , 357 stapedial otosclerosis 359 vestibule contact 357 visualization titanium total prosthesis see Fisch titanium total prosthesis (FTT) total ossicular replacement prostheses (TORP) 58, 123 results 118, 120, 122, 123, 286 tragal cartilage 65, 124 canal wall reconstruction posterior 169 posterosuperior FTT 66 cartilage disk harvesting/ preparation 83 harvesting 64, 70, 85 tragal perichondrium harvesting 70, 85, 101 oval window covering 70, 73, 90 perilymph fistula closure 272 posterosuperior canal wall reconstruction titanium neomalleus incorporation 86 transcanal approach 11 myringoplasty 8, 9, 11 surgical steps surgical technique 13 transmastoid drain 38, 47, 112, 124, 203 with tympanoplasty 169 temporary 32 trauma malleo-stapedotomy with mobile footplate 118 tympanic membrane perforation 13 tubotympanic sheeting 189, 203 tympanic annulus exposure in canalplasty 138 missing 35 repositioning 27 separation from sulcus 33, 43 visualization tympanic bone atretic 142 exposure 23 lateral surface exposure malformation 139, 140, 142 tympanic cavity pneumatization 330 underdevelopment 139, 140 tympanic isthmus 104 tympanic membrane adhesive retraction 311, 312 atrophic 237 FTT head adaptation 81 grafting technique 11 12, 16 retroauricular approach 25, inward displacement 237 perichondrium with neomalleus introduction 86 pouch formation 88 reconstruction 169 remnant for grafting 12 retraction 318 stability 125 ventilating tube 128 see also perforation tympanic ring elevation 227 lowering of inferior 182 tympanic spine anterior 227, 228, 229 posterior 226, 229 tympanic sulcus bone ledge 183 combined grafting 186 drilling new 29, 35, 46 tympanoplasty type III 92, 94 tympanoplasty type IV 95 formation of new 172, 183, 189 atretic ear 143 separation from annulus 33, 43 tympanoantrotomy, retroauricular closed 328 tympanomastoid cell tracts, radical exenteration 170 tympanomastoidectomy closed cavity 152, 156 cholesteatoma removal 334 revision 316 surgical site 168 intact canal wall 156

14 396 pneumatization extent 310 tympanomeatal angle, anterior blunting 43 opening 135 preservation 26 skin preservation 204 tympanomeatal flap 16, 238 connective-tissue graft for repair elevation 26, 29, 33 FTT 97, 98 neomalleus with stapedotomy 85, 87, 100 fenestrated ears 272 FTT 66, 97, 98, 125 incisions 100, 239 incus interposition 53 incus-stapedotomy , malleo-stapedotomy 238, 239, 240, 282 malleus fixation 271 neomalleus with stapedotomy 84, 85, 86, 87, 100 ossiculoplasty 56 perforation 277 posterosuperior 177 repair of tears 290 repositioning 31, 66, fenestrated ear 274 round window temporary access 129, 130 Spandrel prosthesis 64, 65, 72, 125 titanium stapes prosthesis introduction 247 width 289 tympanometry 2 tympanoplasty anterior underlay and posterior overlay grafting 186, with tympanoplasty 160, 168 definitions 2, 8 first-stage 113, 114, 186, 189 HRCT special applications imaging for overlay grafting 188, pneumatization 308 postoperative care 3 4 second-stage 184 special applications staged 188, 189, 204 type III 116, 187, 204 air bone gap closure 122, 123 with combined underlay grafting of tympanic membrane 91, 92, with overlay grafting of tympanic membrane 94 results 122, 123 type IV 95 96, 184, 188, , 204 tympanoplasty microscissors 88, 97, 248, 250 tympanoplasty scissors 63 tympanosclerosis bone atrophy 309 stapes surgery 274, tympanosclerotic plaque 275 removal 276 tympanotomy, posterior 38, 103, 209 active middle ear device 215 cholesteatoma with tympanoplasty 160 tympano-zygomatic bones, pneumatized 300 U underlay 11 12, 47 anterior 12, 16 anterior bed 30 anterior reperforation 43 combined anterior 25, sites of support 27, surgical steps combined grafting 186 complications 43 subtotal perforation 34 V Valsalva maneuver 7 ventilating T-tube, permanent 128, 129 ventilating tubes introduction 128 temporary 126, transportation 127 on tympanic membrane 128 ventilation routes of attic 104 vertigo fistula test 2 gold stapes prosthesis oval window membrane palpation 268 perilymph fistula 271 prosthesis length 355 revision stapedotomy 357 vestibular function loss 368 vestibule air in 270 blue area 261 closure 289 fistula 362 incus-stapedotomy prosthesis advancement 233 prosthesis penetration 363 sealing 288 titanium stapes prosthesis contact 357 vestibulotomy, anomalous facial nerve , 261 Vibrant Soundbridge (VSB) 215, vibrational energy, titanium stapes piston 282 W water test for epitympanic patency 38, 47 wire-connective-tissue prosthesis 248, connective tissue fixation 250 length checking 251 loop formation 251 migration 267 perilymph fistula removal 267, 271 stapes surgery results 278, storage 251 wire-bending die 251