Abstract
A 45-year-old housewife had a history of left otitis media. Examination of the left ear revealed an attic perforation with an opaque pars tensa. There was a 20 dB air-bone gap. X-rays showed an under-developed mastoid, diffusely sclerotic, with clouding throughout.
A left radical mastoidectomy was performed. A monolocular cholesteatoma with fistula in the ampulla of the lateral semicircular canal was found in the epitympanum, accompanied by a diffuse granulomatous mastoiditis and osteitis throughout the rest of the mastoid process. There were no ossicles. However, neomembrane was attached spontaneously to the fossa ovalis, forming a well-functioning natural type IV tympanoplasty. Removal of all diseased tissue and a wide exposure of the attic and aditus were carried out. Fascia tissue was used to close the labyrinthine fistula. No attempt was made to remove the neomembrane completely covering the middle ear. Postoperatively, audiological examination revealed a complete closure of air-bone gap.
The authors emphasized the usefulness of the sound conducting system which is shaped and preserved by Nature.
