Hearing After Surgery in Chronically Discharging EarsII. Radical operation

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Abstract
Results are reported in a series of 123 radical operations with a window plasty (Wullstein Type No. IV) in chronically discharging ears. Practically useful hearing was obtained in 31 per cent of the total series. The results were somewhat better (41 per cent) if the pars tensa remained as contrasted with cases of missing tympanic membrane (21 to 31 per cent). Only cases with sufficient cochlear reserve were used in calculating the percentages (90 ears). Causes of failure were: infectious sloughing of the graft; development of a late perforation due to insufficient nutrition; development of an adhesive middle ear. A modified procedure is described in cases of totally absent pars tensa. In bone-conduction measurements, 26 ears showed a postoperative improvement of 10 db or more. This is ascribed to the liberation of the labyrinthine windows; thus, in chronic ears, a lowered bone conduction cannot be taken as a definite proof of cochlear damage preoperatively. Good speech scores are considered more reliable indications of sufficient cochlear reserve.