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

Abstract

The ultrastructural appearance of the regenerated middle ear mucosa--found at the second operation of staged intact canal wall tympanoplasty (ICWT) with mastoidectomy--has been evaluated with the transmission electron microscope. The regenerated epithelium showed all the morphologic characteristics of the normal middle ear mucosa: ciliated cells, nonciliated cells, and secretory cells. All of these (including goblet cells) have been found in the specimens. It is concluded that a normal middle ear mucosa regenerates to cover all denuded bone surfaces after the first operation of staged ICWT with mastoidectomy, when silicone rubber sheeting has been used to prevent adhesions and maintain an air-containing middle ear space.

Effect of a large‐sized silicone sheet upon recovery of mastoid aeration after mastoidectomy

“…On the other hand, our present observation revealed that the regeneration of the mucosa was partial except in one case. It seems to take a long time for such complete regeneration of mucosa in the excavated mastoid, as was reported by Gamoletti et al 8,15,16 …”

“…On the other hand, our present observation revealed that the regeneration of the mucosa was partial except in one case. It seems to take a long time for such complete regeneration of mucosa in the excavated mastoid, as was reported by Gamoletti et al 8,15,16 Moreover, because no positive correlation was observed between the regeneration of mucosa and the recovery of aeration, it is assumed that the recovery of mastoid aeration owing to the large-sized silicone sheet is not necessarily caused by good or poor regeneration of mucosa. Although it may be a matter of the silicone sheet preventing healing with adhesion as mentioned above, another important factor for the recovery of aeration may be shrinkage of the exudate and clots retained within the mastoid due to organization after surgery.…”

Influence of middle ear mucosal condition on post-tympanoplasty audiologic outcome

“…Using silicone sheets to prevent adhesions between tympanic grafts and the raw bony surface of the middle ear as well as to allow normal mucosal regeneration to take place in the middle ear, shows the importance of middle ear mucosa [15,16]. Restoration of aeration in the tympanic cavity after surgery appears to depend upon whether or not air comes into the tympanic cavity through the adjacent Eustachian tube [17].…”

Factors affecting recovery of mastoid aeration after ear surgery

“…A silastic sheet was used to prevent adhesions between tympanic grafts and the raw bony surface of the ME as well as to allow normal mucosal regeneration to take place in the ME [3,4]. Sanna et al [13] reported that a silastic sheet should be used to cover the medial wall of the ME from ET to the mastoid process.…”