OtoRhinoLaryngology Portal

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OtoRhinoLaryngology Portal Video Collections

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Carbon Dioxide (CO2)-Laser Tympanostomy

                                 Before                                                              After


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.

Grommet Inserter

Figure 1 


Figure 2 

 Figure 3

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. 

Myringoplasty - Harvesting Temporalis Fascia Graft


           Temporalis fascia layer (Star)

Sutured scalp.

                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

 The appearance of tympanic membrane one month after myringoplasty.  Remnant of temporalis fascia is still seen (+).  The fascia acts as a scaffold for new epithelial growth to bridge the defect.  The remnant will thin out over time to make it more compliant for sound energy transfer.

Cartilage Button Graft

Ossiculoplasty for Otosclerosis

Teflon piston anchored at long process of incus with its tip seen in the stapedotomy hole.  Gelfoam was added to cover the opening around the piston tip.

Endoscopic Stapedotomy & Tympanoplasty

Cholesteatoma Surgery



i.Removal of all diseased cells and mucosa.

ii.Creation of a single, smooth, non-doctor dependent, non-discharging cavity with good hearing preservation and no dizziness.


Ref: KP Mowarni.  How I Do It: Inside-Out Mastoidectomy. J Ind Soc Otol. 2002:1(1):1-5.

Cortical Mastoidectomy

This is an operation in which the mastoid antrum and air cells are converted into single cavity with preservation of middle middle ear content. 
Its indications include:
i. Acute mastoiditis not responding to medical therapy.
ii. Mastoid abscess.
iii. Recurrent or chronic otitis media in which diseased mastoid suspected to be the reservoir of infection.
iv. As preliminary approach to other surgical procedure e.g. cochlear implant, vibrant soundbridge placement, facial nerve decompression, etc.

Simple Cortical Mastoidectomy

Mastoidectomy: Modified Radical


               Endaural skin incision           Retraction of skin & exposure of mastoid


 Peeling off keratin flakes from the matrix            Aditus & scutum area

            Drilling the bridge                      Mastoid packing after meatoplasty made

Cochlea Implant


                    Figure 1                                                 Figure 2



                   Figure 3                                                 Figure 4


Figure 1: Posterior tympanotomy after cortical mastoidectomy.

Figure 2: Implant coil showing the channels (interrupted blackened areas).

Figure 3: Insertion of coil into opening made near round window/promontory area.

Figure 4: View at completion before skin closure.


Impedance tests performed for integrity of electrode placement.


Surgery performed by Professor Prepageran Narayanan from University of Malaya Medical Centre.

Implant featured is from MED-EL (Model Sonata 100).

Right Cochlear Implant Surgery

Prominent Ear Correction