CHAPTER 81 A tympanoplasty is the repair of the tympanic membrane (eardrum). A brief description of the procedure follows: 1. A Richards speculum of appropriate size is placed in the ear canal. 2. A Crabtree wax curette is used to remove wax from the canal. 3. A Jordan oval knife may be used to incise the tympanomeatal junction. 4. A Rosen needle is used to elevate the skin of the canal. 5. Richards cup forceps are used to clean all epithelium from the eardrum perforation. 6. An ototome drill with microburrs may be needed if the perforation is not clearly visible. 7. A House pick is used to explore the middle ear for ossicle mobility. 8. Richards alligator forceps are used to remove any epithelium in the middle ear. To harvest a graft from the temporalis muscle, a Lempert elevator may be used to separate fascia from the temporalis muscle. A strabismus scissors is used to cut the fascia, and a Sheehy fascia press is used to thin the fascia before placement. 9. Richards alligator forceps are used to place the graft over the perforation. An ossicular reconstruction may be performed; a brief description of the procedure follows: 1. A Bellucci scissors is used to cut soft tissue. 2. A Mueller malleus nipper is used to loosen the bones. 3. A House sickle knife is used to free the incus from the stapes. 4. Richards alligator forceps are used to remove the bones or fragments. 5. A PORP (partial ossicular replacement prosthesis) is needed to replace several bones. 6. A TORP (total ossicular replacement prosthesis) is needed when all middle-ear bones are removed.
Tympanoplasty
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