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
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.
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.
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
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).