Transcanal tympanoplasty: a 15-year report.

The data presented would seem to support the following conclusions: 1. Transcanal tympanoplasty employing connective tissue underlay grafts, ossicular bone prostheses, and avoidance of mastoid exposure, unless irreversible disease is present, seems to meet contemporary standards of efficacy, safety, and long-term stability when performed on patients with either chronic suppurative otitis or atelectatic otitis. 2. Although chronic suppurative otitis and atelectatic otitis have differing characteristics and are of seemingly different pathogenesis, no statistical differences were found in the pattern of ossicular destruction or in their response to surgical intervation. Hearing results, long-term stability of results, and pattern of complications had no significant differences. 3. Hearing results in those patients with destruction of the malleus handle in whom an L-shaped prosthesis was used were significantly different and poorer than when the malleus was present. A different approach, perhaps employing homograft tympanic membrane with incorporated malleus and staging, may be indicated for these patients. 4. The use of polymeric silicone film and homograft nasal cartilage was associated with a significant number of complications and has been abandoned, substituting instead absorbable gelatin film and ossicular bone transplants. 5. Since no significant changes were seen following one year's observation, this period would seem to be statistically suitable for analysis of results. This conclusion can only be applied to those patients with either chronic suppurative otitis or atelectatic otitis and in whom the surgical procedures herein described were applied.