Surgery of the tympanic bulla (otitis media and nasopharyngeal polyps).

Surgical management of otitis media includes the following options: myringotomy, flushing of the tympanic cavity, lateral bulla osteotomy, ventral bulla osteotomy, and curettage of the tympanic cavity. Combining one of the above procedures with an operative procedure of the external ear canal is frequently indicated because otitis media commonly accompanies chronic otitis externa. The selection of a surgical procedure to treat otitis media should be based on duration of clinical signs, response to previous treatment, the condition of the external ear canal (vertical and horizontal parts), and the familiarity of the surgeon with the different approaches and techniques. Nasopharyngeal polyps may be removed by excising them from the pharynx, external ear, or middle ear. Because of their frequent involvement of the middle ear cavity, nasopharyngeal polyps are best excised by using a bulla osteotomy technique in combination with other excision techniques.