Myringoplasty

Raleigh O. Jones

Confusion has existed for many years regarding the nomenclature used to describe surgery on the tympanic membrane (TM), middle ear, and ossicular chain. Wullstein's classic classification system (types I-V) was based on the relative position of the TM to the other middle ear structures including the ossicles and inner ear membranes. This description was developed prior to the introduction of many of the procedures and prostheses that are used so commonly today in middle ear surgery, so its ability to adequately describe current surgical techniques is limited. Consequently, the term tympanoplasty by itself is not adequately descriptive, simply indicating some sort of reconstructive surgery on the TM or middle ear. It is therefore necessary for the surgeon to use further descriptive terms in addition to the term tympanoplasty to communicate effectively which procedures are being described.

The term myringoplasty refers to reconstructive surgery that is limited to the TM. It was actually introduced by Berthold, who successfully closed a TM perforation using a full thickness skin graft in 1878.2,3 He was the first to report the use of autologous tissue in an effort to repair the TM; prior to that, several different artificial or animal-based materials were used dating back to as early as 1640. By definition, any manipulation of the ossicular chain is beyond the scope of a pure myringoplasty. Because the term tympanoplasty includes surgery on both the TM and middle ear, however, many cases of myringoplasty are labeled tympanoplasty by surgeons, further adding to the confusion. The terms myringoplasty and tympanoplasty without ossicular reconstruction are synonyms unless other manipulation of the middle ear such as removal of cholestea-toma is included in the tympanoplasty procedure. Within the more limited surgery of the TM, many different approaches to myringoplasty have been described.

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