By John L. Dornhoffer

This publication, written through foreign specialists, is a close advisor to the Eustachian tube, with emphasis on these facets of such a lot relevance to the practitioner. the hole chapters record the medical anatomy and supply crucial details on body structure, with clarification of the recent version of tubal mechanics. analysis and treatment for the patulous Eustachian tube are then mentioned, putting certain emphasis on a singular conservative therapy routine that has confirmed to be a step forward for sufferers with this medical syndrome. another vast bankruptcy examines total functionality of the Eustachian tube, essentially from the center ear surgeon’s perspective. Tuboplasty approaches, together with laser tuboplasty, and tympanoplasty are defined, and the consequences of other center ear pathologies for surgical procedure are defined. The formerly unpublished remedy tools which are defined during this publication could be worthy in making sure the absolute best medical outcomes.

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It is helpful to cut the palisades like shingles and to pose them like shingles on a roof (Figs. 6). Silastic sheeting of tympanic membrane and posterior wall reconstruction helps to avoid major granulation tissue growth in the early postoperative period (Fig. 7). 52 4 Tubal Function from a Middle Ear Surgeon’s Viewpoint Fig. 3 Materials for Reconstruction of the Ossicular Chain A broad variety of materials are used for reconstruction of the ossicular chain. A patient’s own material remains the gold standard.

In cases of cholesteatoma, the use of a patient’s own ossicles should be avoided in order to prevent recurrences. Homogeneous ossicles have been widely used with satisfactory results regarding audiology and middle ear acceptance. However, because of the risk of transmitting viruses (HIV, hepatitis) and prions (Creutzfeldt–Jakob disease), the use of homogeneous ossicles has been almost completely abandoned. Heterogeneous materials are not used in middle ear surgery. 1 Alloplastic Materials Since the origination of tympanoplasty, alloplastic materials have been used extensively and uncritically.

Whereas the morphologic aspect of the Eustachian tube and of the surrounding tissue was normal in 26 of the patients, 11 had a hypotrophy of the medial pterygoid muscle and 10 had a hypotrophy of Ostmann’s fat pad. Seven had both. The active role of the medial pterygoid muscle is the basis for a completely physiotherapeutic approach [210] when treating a pET. The aim of the concept of “dynamic stabilization” is to activate the third hypomochlion of the tensor veli palatini muscle, the medial pterygoid muscle and the paratubal muscles.

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