Gelfoam myringoplasty, repair of bilateral tympanic membrane perforations with the use of operating microscope

PREOPERATIVE DIAGNOSIS:  Bilateral retained tympanostomy tubes with underlying tympanic membrane perforations.

POSTOPERATIVE DIAGNOSIS:  Bilateral retained tympanostomy tubes with underlying tympanic membrane perforations.

OPERATION PERFORMED:  Gelfoam myringoplasty, repair of bilateral tympanic membrane perforations with the use of operating microscope.

ANESTHESIA:  General anesthesia.

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS:  Minimal.

PROCEDURE IN DETAIL:  The patient was taken to the operating room and placed supine on the operating room table.  General anesthesia was induced via a facemask.  The operating microscope with a 250-mm lens was placed on the patient’s right ear.  A speculum was placed in the external auditory canal and a cerumen curette was used to remove wax that was present.  There was a retained tympanostomy tube present in the tympanic membrane.  It was removed with the alligator forceps revealing underlying tympanic membrane perforation.  The remainder of the perforation was flushed with a Rosen pick.  The site of the bleeding was removed using a cupped forceps.  A piece of gelfoam was then compressed and triggered.  The appropriate shape was placed over the perforation with care taken to ensure the entire perforation was covered in its entirety by the gelfoam.  Initial layer of gelfoam was then packed lateral to that to secure it in place.  Attention was then turned to the opposite ear where the identical procedure was performed with similar findings.  The patient was then reversed from anesthesia and taken back to the recovery room in stable condition.