Regenerated Middle Ear Mucosa after Tympanoplasty

Abstract

The surgeon’s attitude towards the diseased middle ear mucosa during intact canal wall tympanoplasty has remained a controversial problem. Our approach consists of the complete removal of the irreversibly diseased mucosal lining. A planned staged operation has been carried out in most cases of tympanoplasty with the use of Silastic sheeting. At the time of the second operation, the middle ear and mastoid process appear to be lined by the regenerated mucosa and pneumatized. 54 mucosal biopsies taken during the second stage of the operation showed a normal flat, cuboidal and pseudostratified ciliated epithelium with functional features (secretory granules, microvilli and cilia). It is concluded that the diseased middle ear mucosa can be removed whenever necessary during staged closed-tympanoplasty operations because under the Silastic sheeting the mucosa will be regenerated within 12 months.

To pack or not to pack? A contemporary review of middle ear packing agents

“…Among the nonabsorbable MEPAs, silicone products remain fairly common. Thus far, silicone products have been successfully used as ventilation tubes,26 TM grafts,27 eustachian tube plugs,28 and as external14, 29 and middle ear packing agents 19, 24, 30–32. Generally, these products are well tolerated, safe, biocompatible,25, 33 and invoke no obvious inflammation responses 24.…”

“…Generally, these products are well tolerated, safe, biocompatible,25, 33 and invoke no obvious inflammation responses 24. Most importantly, silicone products have been discovered to significantly impede adhesion formation between TM grafts and injured promontory mucosal tissue,20, 24, 31 to enhance ME re‐epithelization, and to promote ME aeration 24, 30, 31. Autopsies of six patients with permanent implantation of Silastic (silicone plastic, silicone elastomer) sheeting in the ME showed no evidence of long‐term (up to 21.2 years) adverse effects such as rejection, chronic inflammation, and foreign body reaction 24.…”

Regenerated Middle Ear Mucosa after Tympanoplasty. Part I. Transmission Electron Microscopy

“…on the contrary, described a healthy and typical mucosa in all cases. Gamoletti et al 5 showed, with light microscopy, that normal middle ear mucosa regenerates after the first operation of staged intact canal wall tympanoplasty (lCWT), with mastoidectomy performed in badly infected ears.…”

Silastic coated incus in tympanoplasty: a preliminary report

“…In order to prevent adhesions in ears with a severely damaged mucosa, several authors recommend routine two-stage operations with silastic sheeting or paraffin filling of the tympanum, the epitympanum, and the facial recess at the first stage (e.g. Sheehy, 1973;Ojala et ai, 1981;Gamoletti et al, 1982;Rambo, 1961). However, this recommendation should be related to the fact that it is possible, by means of only one operation, to achieve a dry, safe ear and satisfactory functional results in about half of the patients with pronounced pathology of the middle ear (Table IV).…”