OSSICULAR RECONSTRUCTION
Sasan Dabiri, M.D.
Assistant Professor
Department of ORL-HNS
Amir Alam Hospital - TUMS
CLASSIFICATION
Wullstein classified the middle ear operations as types I through V, based on
concepts of sound transformation at OW and sound protection of RW
A modified version of Wullstein's classification for tympanoplasty (1990):
Horst Ludwig Wullstein
German ENT Surgeon
1906 - 1987
o Type 1: Repair of
o Type 2: Repair of
o Type 3: Repair of
o Type 4: Repair of
o Type 5: Repair of
TM without altering the Ossicular system
TM & Ossicular chain with restoring Lever mechanism
TM with direct Transduction from TM to Stapes
TM with direct Connection of TM in mobile foot plate
TM with direct Connection of TM in fixed foot plate
TYPE 2 TYMPANOPLASTY
Preserving Lever mechanism
Reconstruction with:
o Synthetic Prosthesis
o Bone Strut
o Bone Cement
TYPE 3 TYMPANOPLASTY
o Stapes Columella
Direct connection between
Tympanic Membrane &
Capitulum of Stapes
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
 Interposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
 Interposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
 Interposition
 Inposition
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
 Synthetic: PORP
 Biomaterials
TYPE 3 TYMPANOPLASTY
o Stapes Columella
o Minor Columella
o Major Columella
 Synthetic: TORP
 Biomaterials (Incus TORP)
TYPE 4 TYMPANOPLASTY
o Major Columella
TYPE 5 TYMPANOPLASTY
REFERENCES
 Nadol Jr. JB, McKenna MJ. Surgery of the ear and temporal bone, 2nd edition, 2005,
Lippincut Williams & Wilkins, Philadelphia, USA
 Tos M. Manual of middle ear surgery – volume 1, 1st edition, 1993, Thieme Medical
Publishers, New York, USA
 http://de.wikipedia.org/wiki/Horst_Ludwig_Wullstein (last accessed: May 2015)
 http://imglisting.com/ear-bone-disease.html (last accessed: May 2015)
 http://www.bornwithcholesteatoma.net/prosthetic-bone-devices/ (last accessed: May 2015)
THANKS FOR YOUR ATTENTION