Generally speaking, however, these operations are not recommended, owing to the impossibility of being able to give a good prognosis, and therefore they can only be considered as experimental.
These operations are contra-indicated—(1) If there be internal-ear deafness.
(2) If the stapes (as shown by tuning-fork tests and Gellé’s test) be ankylosed within the fenestra ovalis, especially in the case of otosclerosis.
(3) If the membrane be completely adherent to the inner wall at its upper posterior quadrant, especially if this is of long standing, as the stapes will almost certainly also be fixed by adhesions.
DIVISION OF INTRATYMPANIC ADHESIONS
The position and extent of the intratympanic adhesions vary exceedingly, and may be the result either of middle-ear catarrh or suppuration. The following conditions may be found:—
(i) Adhesion of the handle of the malleus to the promontory, the rest of the tympanic membrane being movable.
(ii) Adhesions between other parts of the tympanic membrane and the inner wall of the tympanic cavity, either by bridles or bands of fibrous tissue, or by the membrane itself being adherent over a large area.
(iii) Adhesion of the edge of a perforation to the inner wall.
(iv) Adhesions surrounding the articulation between the incus and stapes, and the stapes itself.