Trans-canal ventilation tube insertion in the center below the umbo.
Depends on every single case. if there is no middle ear space even anteriorly , I would prefer to surgically elevate a intact tympano-meatal flap with subsequent cartilage tympanoplasty. I have an unpublished series of patients who have done well on followup with good hearing improvement.
elevation of tympanomeatal flap without tear, then toto cartilage and subannular t-tube. if there is tear of flap during operation, i will schedule the patient for second look after 6 months.
It depends on each case. I think that the most important question to be asked beforehand is “will the surgery improve the symptoms or impact positively on the hearing”? In my opinion, not many cases do benefit greatly from surgery.
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