Thirty-five years have passed since the basic concepts of tympanoplasty were proposed by H. L. Wullstein in 1949. The idea was based on the successful transplantation of a free skin graft across an infected middle ear. The free graft was supported medially by soaked Gelfoammdash;so-called formed dropsmdash;and was in vascular contact only at its margin with the surrounding bony annulus, the annulus fibrosus, and the mental skin, in order to heal and to function as a vibrating membrane. The fenestration operation, with its experience in free skin grafting, laid the groundwork For surgical procedures to improve hearing in patients with chronic otitis media.I first reported on osteoplastic epitympanotomy in 1971. Among the points I emphasized then were the necessity or complete exposure of the epitympanummdash;especially its foremost anterior part, the so-called recessus protympanicusmdash;and a new method of one-stage osteoplastic exposure of the main focus of disease in the epitympanum. The cholesteatoma findings are so variable that during the operation one should always search first for its origin and its pathways of progression, starting in the epitympanum and not in the mastoid, in order to operate as exactly and conservatively as possible.
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