Strategies of overcoming unsuccessful reconstruction of the middle ear air space — Nasal mucosa transplantation

Abstract

Postoperative drainage of the reconstructed middle ear has to be mostly through the Eustachian tube. In the normal middle ear, the Eustachian tube and its orifice area in the tympanum have the densest populations of ciliated cells, which are the major factor promoting the drainage of the whole middle ear cavity. Succesful experiences with tympanoplasty with very fast recovery were usually in those cases with near normal tympanic mucosa, while unsuccessful experiences were mostly in those with defective or wholly pathological tympanic mucosa. Even in the latter cases, the Eustachian tube and its tympanic orifice frequently have near-normal populations of cilia cells, indicating that even this level of such cells in these areas was not sufficient for post-operative drainage of the whole middle ear cavity. Probably, then, the tympanic cavity itself should have a lining of cilia cells for effective drainage of the middle ear cavity. Drainage should precede ventilation.