Cartilage Tympanoplasty

Cartilage tympanoplasty utilizes the logical application of several techniques for the management of the difficult ear. Cartilage tympanoplasty achieves good anatomical and audiologic results when pathology and status of the ossicular chain dictate the technique utilized.

The commonest techniques involve cartilage palisades and composite cartilage-perichondrial island grafts. There are many variations on the shape, size and thickness of the cartilage grafts. Cartilage is more rigid and resists resorption and has long-term survival and is nourished by diffusion.

Significant hearing improvement is seen in the atelectatic ear. Cartilage helps to reconstruct the TM with good anatomic results compared to traditional reconstructions. In cholesteatoma, cartilage tympanoplasty using the palisade technique resulted in precise reconstruction of the TM and helped reduce recurrence.

Disadvantages include time consuming to shape cartilage. The rigidity of cartilage raises concern about audiologic outcome.


Otosclerosis is a metabolic condition in which there is a hardening of the base of the stapes. This decreases the vibration of sound into the inner ear, resulting in hearing loss. Surgical correction of this condition is called stapedotomy. The arch of the stapes is removed and a piston is placed from the incus through an opening in the base of the stapes.

A modified hearing surgery on stapes, called stapedotomy makes a tiny hole in the footplate instead of removing the whole stapes with a micro drill or with a laser. This surgery can most safely open the base of the stapes with minimal trauma to the delicate inner ear structures beneath. The success rates of this surgery are excellent, and the risks to surgery are low. This procedure can be further improved by the use of a tissue graft seal of the fenestra. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis. The CO2 laser allows the surgeon to create very small, precisely placed holes without increasing the temperature of the inner ear fluid by more than one degree. Stapes surgery rarely is done in infants or children with congenital stapes fixation due to the risk of permanent hearing loss following stapes surgery.

Removal of Granulation of External Auditory Canal (EAC) using lazer

The application of lasers in otolaryngology is increasing due to its precision, ablative and coagulative properties, and minimal thermal damage to adjacent healthy tissue. Different types of lasers used in inner ear problems and middle ear surgery include potassium-titanyl-phosphate, carbon dioxide, neodymium-yttrium-aluminum-garnet, argon, and pulsed dye lasers.

The high specificity carbon dioxide laser in water absorption makes it an ideal tool for precisely controlled incision, excision, vaporization and ablation with simultaneous homeostasis in small vessels. CO2 laser energy is not spread within tissue. It has a superficial action limited to the upper layers of tissue, leading to minimal damage to adjoining tissue volume. CO2 laser surgery is safe and effective for otologic applications. CO2 laser excision polyps and granulation tissue in the external ear canal, is nearly bloodless.

Laser energy is easily directed at the tissue target using a micromanipulator or the new flexible laser fiber. The endoscopic application of a new flexible carbon dioxide laser fiber for management in pediatric airways lesions is found to be effective. The laser can remove final bits with no vibratory energy. They are helpful when removing granulation tissue from around stapes, cholesteatoma around stapes.
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