Abstract
Repeated infections of the middle ears often lead to damage of the eardrums and the ossicles and result in impairment of the hearing and equilibratory functions. Tinnitus in the affected ears is often complained of. The eardrum defects in the patients with persistent chronic otitis media are usually difficult to heal spontaneously. Therefore, an early surgical intervention is needed in these patients for the restoration of normal functions and the prevention of ongoing complications. In conventional chronic otitis media surgery the ear canal skin will be separated from canal wall and the middle ear cavity opened. The eardrum is repaired with a piece of temporalis fascia harvested from pre- or post-auricular incision. Because the operation incision is an open wound, ear canal packing and compressive dressing will be given after surgery. Post-operative oral antibiotics and prolonged wound care will be needed. Frequently the patients are reluctant to receive necessary surgery for post-operational wound pain, prolonged follow-up care and interference to their daily life. Hence, the otologic surgeons in the otolaryngology department of
Taipei Veterans General Hospital develop a mini-invasive transcanal middle ear microsurgery to improve the surgical techniques. In brief, a small incision in the post-auricular, supra-auricular or conchal area is made and a piece of subcutaneous tissue or perichondrium/cartilage composite graft is harvested. After elevation of a small tympanomeatal flap through the transcanal route the eardrum is repaired with subcutaneous tissue and the ossicles reconstructed with conchal cartilage. The compliance of the patient to this surgery is usually good and almost no severe discomfort was complained of during the whole procedure. The patient could be discharged shortly after the surgery and the stitches removed on the 7th day. The patients are allowed to continue their daily activity and sedentary work immediately after discharge. In comparison with the conventional endaural or post-auricular surgery this mini-invasive transcanal middle ear microsurgery has the advantages of less medical expenses, better wound healing, less surgical complications and better compliance of the patients. However, because of the limitation of the surgical field exposure those patients with narrow ear canals, mastoiditis and middle ear cholesteatomas are contraindicated for this mini-invasive surgery.