The aim of myringoplasty is to restore the normal functions of the TM. Myringoplasty, also known as “type 1 tympanoplasty,” refers to surgery performed on the eardrum. The TM ( white arrow ) is diffusely thickened either from scarring, grafting, or myringitis. Note the bone defect in the anterior wall of the EAC ( yellow arrow ) just lateral to the annulus created during surgery. The most common finding on CT is a “box-like” appearance to the EAC from bone drilling at the isthmus level and loss of bone anteriorly deep in the EAC secondary to “blue lining” giving the appearance of an EAC–temporomandibular joint “fistula” ( Fig. 1 ).Īxial CT image from a patient following transcanal surgery. Postoperative change on imaging may be minimal in cases of EAC stenoses or could be extensive in patients with EAC atresia. This is a procedure enlarging the EAC facilitating immediate or future surgery by the transcanal approach. The postoperative recovery period is 4 to 5 days longer than that of the transcanal approach. It does require the use of a mastoid dressing that can be removed the next day. It provides the best exposure to the EAC and facilitates tympanoplasty when the transcanal approach cannot give the necessary visualization. It is the primary approach for many neurotologic procedures, such as the translabyrinthine, retrosigmoid, or retrolabyrinthine surgery. The mastoid cortex and subjacent air cells are drilled away providing exposure to the ME and mastoid. As a result, patients normally return to their presurgical functional status within 1 to 2 days.Īn incision is made posterior to the ear, which is reflected anteriorly.
Advantages include limited surgical dissection so postoperative pain is diminished. A widened appearance to the EAC may be evident from drilling of bone at the level of the isthmus. There may be little evidence of postoperative change in the EAC. It is the preferred approach for EAC stenosis, exostosis, osteomas, myringitis, repair of central perforations, placement of pressure equalization tubes, and so forth. Visualization of the anterior portions of the EAC near the TM and protympanum is limited. Areas accessible include the EAC central tympanic membrane (TM) the central ME ossicles (to include the stapes) tympanic sinus and portions of the facial recess and hypotympanum. This approach is used for disease processes that can be adequately visualized in the external auditory canal (EAC) with the entire surgery performed through the EAC. The following approaches and procedures may be performed singularly or in combination. The goal of surgery in the ME and mastoid is the elimination of disease and, if possible, the preservation or restoration of normal function. Knowing the normal postoperative appearance is the key to recognizing signs of recurrent disease. This is greatly simplified by knowing the surgical procedures used and the expected postoperative appearance. Interpreting CT or MR imaging examinations performed on patients with a history of middle ear (ME), mastoid, or neurotologic surgery can be challenging.
These are reviewed and illustrated in this article. Interpreting CT or MR imaging examinations performed on patients with a history of middle ear, mastoid, or neurotologic surgery can be challenging.
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