Abstract
For the successful operation of the middle ear with chronic otitis media preservation' or reconstruction of both the basic anatomical bony structure and of the ossicular chain are deemed necessary.
In cases with cholesteatoma the bony lateral wall is often defective. Reconstruction of this b ony wall using cartilage plates should be accomplished in order to prevent the postoperative complication, retraction cholesteatoma.
In cases where only the stapes is intact, continuity between the stapes and the tympanic graf t can be obtained by interpositioning one or more plates of cartilage between them.
These plates of cartilage are very useful because they are more stable than a single strut.
In cases where super structure of the stapes is missing improvement of hearing by surgery can only be expected by a 2-stage operation.
Surgery to the middle ear often involves surgical insult to the ossicles as well as the tympanic membrane, therefore, it is most important to perform the surgery to these fine structures, talking into careful consideration their postoperative distortion.
The underlay grafting seems to be a better procedure than overlay grafting in prevention of such postoperative distortions.
