Intact-bridge tympanomastoidectomy.

In recent years closed-cavity (intact wall) tympanomastoidectomy has been described and recommended by many. The pendulum now is swinging back to open-cavity tympanomastoidectomy. The literature in this regard is reviewed. In all patients with chronic otitis media and mastoiditis with intractable tissue pathology, the primary objective is total eradication of disease with a dry, safe ear; a concomitant but secondary objective is hearing retention and restoration with tympanoplasty techniques. Over a 3-year period we have used a one-stage procedure called intact-bridge tympanomastoidectomy (IBM) that fulfills the desirable objectives of both open- and closed-cavity tympanomastoidectomy. The salient features include good exposure as in open-cavity tympanomastoidectomy, maintenance and widening of the middle ear space by bony bridge retention and facial buttress sculpturing to enhance grafting and ossiculoplasty such as TORP or PORP as in canal-up tympanomastoidectomy, and enhancement of mastoid obliteration for large cavities by blocking the aditus with bone paté or cartilage and by providing a separation between middle ear and mastoid. Specific methods, techniques, and results will be presented and discussed.