Fenestration tympanoplasty: an adjunctive technique for hearing restoration.

Two-staged fenestration tympanoplasty is a form of total tympanoplasty type V that incorporates the mastoidotympanomastoidectomy (radical mastoidectomy) and revives the Lempert horizontal semicircular canal fenestration operation. It is valuable when the usual and customary single or two-staged tympanoplasty procedures fail to conserve or restore hearing in the operative management of otitic disease. Two-staged fenestration tympanoplasty is also indicated in audiometric failure tympanoplasties, in oval window surgery failures in the absence of supporting ossicles and in the presence of a fibrosed or sclerosed oval window, and in severe otitic oval window-round window-posterior tympanic recess-tympanic orifice eustachian tube infection, which can only be completely removed by the mastoidotympanectomy. Total tympanoplasty type V as described here has produced serviceable hearing for human conversation and the speech frequencies to the 15-dB to 25-dB levels, and a 20 dB average in 19 of 21 patients operated on for a 90% success rate.