Tympanoplasty for COM without cholesteatoma
Tympanoplasty was also performed under general anesthesia for children and under regional local anesthesia for adults (2% lidocaine hydrochloride and 1:50000 epinephrine) with injection on the skin of the tragus and ear canal. The graft material (including the perichondrium and cartilage) was harvested from the meatal surface of the tragus, and the wound was sutured with Vicryl 5-0 (Coated VICRYL® polyglactin 910 Suture, Ethicon, US). After denuding the perforated edge of the ear drum, a transmeatal incision (straight upward) was made to elevate the tympanomeatal flap. All the inflammatory tissue in the tympanic cavity was then completely removed, and the tympanic cavity was cleaned using saline irrigation. Furthermore, the ossicular chain was checked, and ossiculoplasty was simultaneously performed if such was deemed necessary. The skin of the anterior canal and the annulus were elevated, and surgifoam (Spongostan Gelatin Hemostatic Sponge, Ethicon, US) soaked with ofloxacin (3 mg/mL) (Tarivid; Daiichi Sankyo, Japan) was placed in the middle ear cavity. The perichondrium graft was introduced underneath the perforated ear drum; then, the tympanomeatal flap was repositioned. The ear canal was then packed with surgifoam soaked with ofloxacin.