DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left conductive hearing loss.
POSTOPERATIVE DIAGNOSIS: Left conductive hearing loss.
OPERATION PERFORMED: Left tympanoplasty with ossicular chain reconstruction and use of operating microscope.
SURGEON: John Doe, MD
ANESTHESIA: General.
ANESTHESIOLOGIST: Jane Doe, MD
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old female with a history of decreased hearing over the past couple of years. She has become much more aware of the hearing loss. She was found to have a conductive hearing loss in the left ear with absent reflexes. She was thought to have otosclerosis. The patient was given options, including use of hearing aid versus surgery versus monitoring. The patient decided to undergo surgical exploration.
OPERATIVE FINDINGS: The long process of the incus was actually eroded. There was a fibrous band between the top of the stapes and the body of the incus. The stapes superstructure was also not intact. The anterior portion of the arch was also slightly eroded with a very thin area of bone. For this reason, a stapedectomy was not performed, but instead a titanium TORP prosthesis was inserted. Cartilage was placed on top of this. The chorda tympani was preserved. The head of the malleus was removed and the incus was also removed. The head of the malleus was placed up into the epitympanic space.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position. Intravenous sedation was performed, and the patient was prepped and draped in the normal sterile fashion. The microscope was draped in sterile plastic. The microscope was brought into the field. The microscope was used throughout the procedure in order to visualize the ossicular chain.
After the patient was prepped and draped in the normal sterile fashion, 1% lidocaine with 1:100,000 epinephrine was injected into the ear canal. A tympanomeatal flap was elevated. Bone was curetted from the posterior superior quadrant. The chorda tympani was preserved. At this time, we could visualize the ossicles, and we could see what the problem was. The problem was that the long process of the incus was a fibrous band. At this time, this fibrous band was not in continuity as palpation of the malleus revealed movement of the incus, but the stapes did not move. On further examination, we could see that the anterior arch of the curve was also very, very thin.
At this time, the fibrous band was cut. The incus was removed, and at first, we were going to put a PORP prosthesis in. However, we realized that it would not fit on top of the stapes because it would not support it, as it was abnormal. For this reason, the decision was made to put a TORP in. The TORP was measured. The head of the malleus was then cut off. We attempted to remove it, but it fell up into the epitympanic space, and we decided to leave it in this area. At this time, the TORP was measured and a 5.75 mm TORP prosthesis was selected. At this time, Gelfoam was packed in the middle ear space. Prosthesis was placed on top of the mobile stapes. The arch of the stapes was used to support the prosthesis. Gelfoam was packed around the prosthesis.
Tragal cartilage was obtained. This was cut and trimmed, and the perichondrium was removed. It was cut and trimmed to fit over the prosthesis. At this time, the cartilage was placed on top of the prosthesis. Gelfoam was packed around this. The eardrum was returned to its normal position. A piece of perichondrium was placed up underneath the eardrum to help support it in the posterior superior quadrant. At this time, the ear canal was packed with Gelfoam. The eardrum was then elevated again to check to make sure the cartilage was in the proper position, and it was. The ear canal was packed with Gelfoam. This was all done under the microscope. The patient was then awakened and taken to the recovery room in stable condition.
