Browsing by Author "Linder, Thomas"

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    Incus & Malleostapedotomy
    (University of Cape Town, 2025-03-08) Harris, Tashneem; Linder, Thomas; Fagan, Johan
    Stapedotomy refers to the calibrated fenestration of a fixed footplate and insertion of a prosthesis. Prof Ugo Fisch first introduced the terms incusstapedotomy where the prosthesis is attached to the long process of the incus, vs. malleostapedotomy where the prosthesis is attached to the malleis handle. The surgical steps of both procedures will be described as per Prof Ugo Fisch. Otosclerosis is the most common indication for stapedotomy. Histology of temporal bone specimens show that there may be a fairly high incidence (up to 30%) of additional malleal fixation in otosclerosis. Hyalinisation and ossification of the anterior malleal ligament are related to the duration of otosclerosis. Fixation of the malleus head and incus body is usually found in narrow external ear canals. The reported incidence of malleal fixation in clinical studies varies significantly for both primary (0.6 - 6%) 3,4 and revision surgery (3-37%).5,6 In a study (unpublished data) conducted by the senior author (T.L), the incidence was found to be 5% with primary surgery.
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    Myringoplasty & Tympanoplasty
    (University of Cape Town, 2025-03-08) Harris, Tashneem; Linder, Thomas; Fagan, Johan
    The goals myringoplasty and tympanoplasty are to achieve a dry, self-cleansing ear while preserving or restoring hearing. Myringoplasty refers to grafting of the tympanic membrane without inspection of the ossicular chain. Tympanoplasty entails grafting of the tympanic membrane with inspection of ossicular chain with/without reconstruction of the middle ear hearing mechanism. Ossiculoplasty is reconstruction of the hearing mechanism using either an autologous graft or prosthesis. Meatoplasty involves enlargement of the lateral cartilaginous portion of the external auditory canal. A narrow entrance to the ear canal within the cartilaginous portion of the canal prevents proper ventilation and self-cleaning of the ear canal and may compromise hearing aid fitting. Canalplasty is partial or total widening of the bony portion of the external ear canal. In order to visualise the tympanic annulus, particularly in anterior or subtotal perforations, canalplasty is essential and may be an integral part of myringoplasty or tympanoplasty.
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    Myringotomy with Ventilation Tube Insertion
    (University of Cape Town, 2025-03-08) Harris, Tashneem; Linder, Thomas; Fagan, Johan
    Ventilation tubes (grommets) are generally inserted for refractory middle ear effusions with persistent conductive hearing loss, present for a minimum duration of 3 months and with hearing loss exceeding 25dB. They may also be inserted as an adjunct procedure in acute mastoiditis secondary to acute suppurative otitis media. Preoperative assessment: •Pneumatic otoscopy to confirm the diagnosis of middle ear effusion •Pure tone audiometry within the preceding 3months, or age appropriate hear-ing test, as well as tympanometry •A middle ear effusion may be caused by pathology (benign or malignant) in the nasopharynx which causes tubal dysfunction. Therefore, particularly in adult patients the nasopharynx should be examined, and the neck palpated for metastases from a nasopharyngeal ma-lignancy •A CSF leak may present as a middle ear effusion. A high index of suspicion is therefore necessary in the presence of a clear serous or watery effusion or when the history is suggestive of a CSF leak