James L. Sheehy

Tympanoplasty: Review of 400 staged cases†

Staging of tympanoplasty is important in the management of patients with chronic otitis media. It allows establishment of an air‐containing middle ear space and adequate postoperative hearing levels in a large proportion of patients with severely diseased ears.

LXXVII Stapes Surgery: Selection of the Patient

During the seven years since re-introduction of the stapes operaxad tion by Rosen, great improvements have been made in surgical techxad nique. One of the most important of these improvements was the concept of total stapedectomy with vein graft and polyethylene prosxad thesis and later the use of a wire prosthesis. These techniques have led to improved results (Fig. 1 ) . Eighty per cent or more of the patients undergoing stapes surgery at the present time can expect permanent improvement in hearing to within 10 decibels of the prexad operative bone conduction level.

LIII Stapes Surgery in Advanced Otosclerosis

Advanced otosclerosis as herein used refers to clinical otosclerosis in which the bone conduction level, averaged in the speech hearing frequencies, is 30 decibels or more with a level of 30 decibels or more at 500 cis. Following successful stapes surgery, a patient with advanced otosclerosis will usually continue to require the use of an aid except for close conversation. This patient was not considered a satisfactory candidate for fenestration surgery.

LXXXII Stapedectomy in the Fenestrated Ear

Shea has always considered the fenestrated ear satisfactory for stapedectomy, although his results have never been as good as in primary stapedectomy. He reports 50 per cent successful results in a series of 34 cases. Two of his failures developed a severe sensorineural impairrnent.i-P He uses an unbeveled polyethylene strut between the tympanic membrane and a vein graft over the oval window. The chorda tympani is impacted into the outer end of the tube to help stabilize it and to prevent perforation of the tympanic membrane.