Symposium: contraindications to tympanoplasty.

Abstract

AbstractA panel on contraindications to tympanoplasty connotes the need for self‐evaluation by the otologic surgeon. A polarity of opinion is developing among tympanoplastic surgeons. There are some who recognize few contraindications in these procedures in contrast to those who are very conservative. The panel has designated absolute and relative contraindications which must be determined according to the surgeon's dexterity and experience. A careful selection of patients in light of the relative contraindications is advocated.The contributors to this panel jointly enumerated the following contraindications, absolute and relative, to tympanoplasty:1. Extensive mucosal deficit (particularly with good hearing in opposite ear).2. Absence of middle ear bony framework (postoperative radical mastoidectomy).3. Non‐existence of stapedial superstructure (poor prognosis).4. Fixation of footplate (poor prognosis).5. Total eustachian tube obstruction.6. Extensive tympanosclerosis.7. Surgery on better hearing ear (except for compelling reason).8. Surgery on only serviceable ear (except for compelling reason).9. Minimum of discrimination is necessary (70–80 is borderline between good and bad prognosis).10. Patients with small air‐bone gap are usually non‐candidates (surgery could make them worse).11. Systemic diseases — i.e., tuberculosis, malignancy, diabetes, circulatory problems (obtain clearance from internist).12. Post irradiation base of skull (interferes with healing).13. Severe allergic disorders.14. Chronic sinusitis.15. Cleft palate.16. Extensive cholesteatoma (particularly with inexperienced aural surgeon).17. Avoid ear preferred by patient for hearing aid (a surgical accident might render ear useless).18. Ear in which previous surgery has been associated with serious complications (i.e., facial nerve paralysis, cerebrospinal fluid leak, lateral sinus rupture).19. Persistent wet ear after adequate local treatment (indicates eustachian tube problems and nasal pathology).20. Tympanoplasty in children not too successful. Eustachian tube does not achieve sufficient growth (until age 10–14 years) to prevent recurrent middle ear infection. There is a high probability of spontaneous healing.21. Age (under three or over 70).22. Fibrosis of middle ear and extensive tympanosclerosis (insufficient blood supply for good healing).23. Obliterative fibrosis of middle ear requiring space creating and adhesion preventing materials.24. Mumps exposure.25. Acute illness.26. Acute traumatic perforation.27. Perfect contralateral ear.28. Real benefit unlikely.29. Inability to remove epithelium at time of surgery.30. Acute or chronic external otitis.31. Unilateral congenital atresia.32. Bilateral congenital bony atresia before age six.