Primary Versus Secondary Ossicular Reconstruction

Whether to repair the ossicular chain at the time of primary cholesteatoma removal or to delay that reconstruction for some months is frequently debated. In reality, most practicing otologists use both strategies depending on circum-stances.3,11 If a second exploration is planned, delaying the ossicular reconstruction is more appealing. A second procedure does permit the middle ear space and tympanic membrane to heal up well in advance of reconstruction and provides additional motivation for the patient to return for the second stage of his or her procedure.

If there is concern about postoperative aeration because of suspected eustachian tube dysfunction, it is often better to wait and make sure an appropriate middle ear space has developed and that the tympanic membrane has healed before attempting to reconstruct the ossicular chain. If there have been failed ossicular reconstructions in the past, or previous operations have been followed with severe postoperative retraction, staging a reconstruction is prudent. Often, the decision to delay ossicular reconstruction is made on the basis of the severity of the disease encountered at the time of primary cholesteatoma removal. If the mucosa has been seriously damaged, is thick, edematous, and large amounts of middle ear mucosa need to be removed, postoperative scarring, fibrosis, and retraction are more likely. The timing of ossicular chain reconstruction is a judgment call that requires significant amounts of experience.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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