Takeshi Kusunoki1*, Saito Kazuya2, Katsuhisa Ikeda3
1Department of Otorhinolaryngology, Juntendo University of Shizuoka Hospital, Japan
2Department of Otolaryngology, Kinki University School of Medicine, Osakasayama, Japan
3Department of Otorhinolaryngology, Juntendo University School of Medicine Japan
Received: 06 December, 2016; Accepted: 27 December, 2016; Published: 28 December, 2016
Takeshi Kusunoki, M.D, Department of Otorhinolaryngology, Juntendo University l of Shizuoka Hospital 1129, Nagaoka, Izunokuni-City, Shizuoka 410-2295, Japan, E-mail:
Kusunoki T, Kazuya S, Ikeda K (2016) Meanings of the Tympanic Mucosa Recovered By Tubotympanoplasty (A Long T-Shaped Solid Silicon Plate in Eustachian Tubal Orifice). Arch Otolaryngol Rhinol 2(1): 079-081. DOI: 10.17352/2455-1759.000031
© 2016 Kusunoki T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Chronic otitis media; Silicone plate; Regeneration of tympanic mucosa, Tubotympanoplasty, gas exchange
We used a surgical procedure suggested by Murata et al. and inserted a T-silicon plate from the tympanic cavity into the opening of the eustachian tube in 2 cases of chronic otitis media. The goal of this surgery was to promote the regeneration and the epithelization of residual mucosa of the eustachian tube. In our results, epitheliums of regenerated tympanic mucosa were histologically examined. Two patients with eustachian tube stenosis demonstrated increased ventilatory function of the eustachian tube and showed epithelium of regenerated mucosa extended toward the mesotympanic and the pretympanic space surrounding the opening of the eustachian tube. Electron microscopic examination of regenerated mucosa of the anterior tympanic cavity, obtained after tubotympanoplasty revealed stratified ciliated epithelium. From above results, our technique suggested to improve the ventilatory function of the eustachian tube, and to promote formation of epithelium of regenerated tympanic mucosa.
Ventilatory dysfunction of the eustachian tube has been said to be one of the causes of acquired cholesteatoma otitis. Clinically, however, normal ventilatory function of the eustachian tube is preserved in some patients with acquired cholesteatoma otitis. Sade’ , described the concept of gas exchange occurring inside the middle ear cavity including the mastoid air cells. Gas exchange is a passive process that moves air into and out of the cavity; that is, in the body, gases move between the closed cavity and the surrounding blood vessels in the mucosa of middle ear in proportion to the gradient of partial pressure, thus equalizing the pressure between the closed cavity and the blood . This gas-exchanging function as well as the ventilatory function of the eustachian tube is necessary for normal functioning of the ear.
In this study, we performed tubotympanoplasty using a T-silicon tube in patients with advanced cholesteatoma otitis who had undergone unavoidable radical mastoidectomy and removal of the mucous membrane of the middle ear. We used a surgical procedure suggested by Murata  and inserted a T-silicon plate from the tympanic cavity into the opening of the eustachian tube. The goal of this surgery was to promote the regeneration and the epithelization of residual mucosa of the eustachian tube and the extension of it toward the opening of the eustachian tube. We then performed the reconstructed ossicular chains as a secondary operation in these patients. The ventilatory function of the eustachian tube and the range of extension of epithelium of regenerated tympanic mucosa, which are related to development of the pneumatization system, were evaluated after surgery. Epithelium of regenerated tympanic mucosa was histologically examined.
Subjects and Methods
Two patients with choleseatoma otitis undergoing radical mastoidectomy and tubotympanoplasty.
We used a surgical procedure suggested by Murata  and performed tubotympanoplasty. Radical mastoidectomy was performed at the first operation. A T-silicon tube (thickness, 0.2-0.5 mm; length, 2cm) that we had made was inserted from the tympanic cavity into the opening of the eustachian tube. Then, as illustrated in Figure 1a, hyperplasia of granulation tissue occurred in the tympanic cavity. The epithelium of the external auditory meatus grew, and extended beyond the granulation tissue, which seemed to function as a footing, and as a result the T-silicon tube was covered with it.
Granulation tissue in the tympanic cavity became fibrotic, and epithelium of the residual mucosa of the eustachian tube regenerated and extended toward the anterior tympanic cavity surrounding the opening of the eustachian tube (Figure 1b).
The secondary operation was subsequently performed. Regenerated epithelium of the external auditory meatus was ablated and then its mucosal epithelium was dissected. The T-silicon plate was finally removed. The dissected mucosal epithelium was turned over and attached to the tympanic wall. Then, the sound-conducting mechanism was restored using residual regenerated epithelium of the external auditory meatus and the temporalis fascia (Figure 1c). We then examined the ventilatory function of the eustachian tube in all patients, by tubal catheterization both before the first operation and after the secondary operation.
- Sade’J, Luntz M, Levy D (1995) Middle ear composition and middle ear aeration. Ann .Otol Rhinol. Laryngol 104: 369-373. Link: https://goo.gl/2bhelr
- Iawano T, Doi T, Hosoda,Y, Ushiro K, Yamashita T (1993) Transmucosal pressure regulation in the middle ear cavity. Practica. Otologica (Kyoto) 86: 1265-1272.
- Murata K, Ohta F (1985) Reconstruction of the Eustachian tube and the anterior tympanum: planned staged tubo-tympanoplasty. Laryngoscope 95: 330-334. Link: https://goo.gl/4qKep0
- Takahashi H, Honjo I, Naito Y, Miura M, Tanabe M, et al. (1997) Gas exchange function through the mastoid mucosa in ears after surgery. Laryngoscope 107: 1117-1121. Link: https://goo.gl/TUuncH