When there is significant middle ear mucosal disease or severely retracted malleus, a fitted sheet of Silastic is placed on the entire promontory area (0.25 mm thickness). Generally the sheeting is fashioned to about 10 to 12 mm in diameter, with a small cutout where the stapes is located. Gelfoam (Pharmacia, Peapack, NJ) is used to pack the eustachian tube. An 8-mm Gelfoam disk is placed on the Silastic sheet medial to the malleus. The middle ear space up to the annulus is filled with one-half of 8-mm disk pledgets of Gelfoam.
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