Sequential shots of endoscopic myringotomy and suction clearance of middle ear fluid in acute otitis media.
CO2-laser tympanostomy is an alternative method to the standard myringotomy and grommet insertion. It is ideal for the purpose of short-tem middle ear ventilation for example in subacute middle ear effusion, barotrauma, and acute otitis media. It has the advantages of simplicity, precision, good homeostasis, and low risk of non-closure. Obviously, no grommet is left in-situ;
thus avoiding tube-related issues.
Figure 1: Inserter device in engaged position shown separately from the grommet in used.
Figure 2: Inserter device in engaged position with the grommet in used attached.
Figure 3: Inserter device in disengaged position with the grommet completely released.
Temporalis fascia layer (Star)
Excised temporalis fascia Pressing to thin-out and making
the fascia even and broader
[If graft thick & small initially]
Large central perforation.
View after perforration edges refreshened and tympanomeatal flap raised. (ME middle ear, F - flap)
Tympanomeatal flap (F) raised upward. (ME - middle ear mucosa, OM-osseous meatus)
View after temporalis fascia in place with flap re-draped.
Gelfoam (G) in place.
Surgicel applied along flap incision line.
Endoscopic view 4 weeks after surgery showing healed myringoplasty. The temporalis fascia graft (F) will become thinner over time similar to the adjacent eardrum.
Video of myringoplasty temporalis fascia harvesting
Healed temporalis fascia harvest incision site.
Harvesting tragal cartilage graft (arrow) with or without its covering perichondrium for eardrum perforation closure.