The history of surgery for chronic suppurative otitis media (CSOM) is littered with stories of techniques and materials that were tried with enthusiasm but without a reasonable expectation of long-term success. The early papers on tympanoplasty, and sadly even some still today, contain numerous short-term follow-up reports of new procedures that looked as if they might revolutionise ear surgery. By the nature of the problem, the longer-term results often proved to be poor and by the nature of humans, the original author didn't report this. As a result, perhaps hundreds of patients elsewhere were subjected to surgery that was already doomed to failure even before the operations started. The journals of the sixties and seventies contain many reports which most would rather forget.

I began my otologic career in the early sixties, at the height of the otologic renaissance, and so often we felt that with just one more push conductive deafness would become a thing of the past. Now we know that the problems of middle ear reconstruction are multifactorial and that we are not simply looking for one single step to restore and maintain hearing and stability. What we need, is a greater understanding of why some procedures succeed and others fail.

Happily in this book, Professor Ars and his team of leading clinicians and scientists, begin by looking at the ranges of causes of the problems. They then move on to examine the essentials needed for getting good results, and they do this in the light of those things which we know at the outset cannot possibly succeed.

Professor Ars has gathered together an excellent group of otologists who start with the initial causes of the problems and move on to look for the essentials of success. Having identified these, they go on to explore how we can lay the foundations to achieve them. Finally, they look at the operative procedures they consider most likely to achieve success.

This is an excellent book, which should improve the thinking behind surgery for CSOM.

Alan G. Kerr, OBE, FRCS

Table of Contents

Dedication, J. Sadé
Preface, A.G. Kerr
Introduction, B. Ars

Part 1: Etio-Pathogenesis of Chronic Otitis Media: Parameters

Environment

Morphofunctional partition of the middle ear cleft, B. Ars and N. Ars-Piret

Pathogenesis of chronic otitis media. Local morphological predisposing factors, B. Ars

Mesenchymal barrier damages

Tympanic membrane lamina propria. Histology and histopatology. Interactions, roles and consequences in chronic otitis media, M. von Unge

Anatomical and mechanical properties of the tympanic membrane, W.F. Decraemer and W. Funnell

Loss of the quality of the mucosa of the middle ear cleft

Mucociliary clearance function of the middle ear cleft in health and disease: An experimental approach using cell culture, Ph. Herman

Mucosal capacity of the middle ear cleft for fluid absorption and clearance, D.L. Mandell and P.A. Hebda

Middle ear cleft pressure regulation. Balance and Imbalance of pressure variations. State of the art, B. Ars

Mechanics of the Eustachian tube, R. Leuwer

Trans-mucosal gas exchange in normal and pathological conditions, R. Kania

Pressure fluctuations in the normal and intact middle ear and its relation to speed of transmucosal gas exchange, J. Dirckx, M. Gaihede, H. Jacobsen, J. Buytaert and
J. Aernouts

Computer modeling in chronic otitis media: Perspectives and limits, S. Ghadiali

Middle ear cleft mucosal conditions and gas-exchange function, H. Takahashi

Middle ear cleft pressure regulation in health and disease. Sustained approach for a central regulating system: the middle ear isobaric system, D. Estève, L. Vecellio and
J.P. Lavieille

Middle ear cleft pressure regulation - the role of a central control system, M. Gaihede, S. Sami and J. Dirckx

Part 2: Pathogenesis oriented therapeutic management of Chronic Otitis Media

Mesenchymal barrier reconstruction

Myringoplasty with fascia. Th. Linder

Cartilage tympanoplasty: A review of materials, techniques and indications, J.L. Dornhoffer

Tympano-ossicular allograft tympanoplasty, B. Ars

Reconstruction of the canal wall, J. Magnan

Rehabilitation of the quality of the mucosa of the middle ear cleft and of the fibrocartilaginous eustachian tube

Mastoid and epitympanic obliteration. The bony obliteration technique, E. Offeciers

Medical and surgical management of Eustachian tube dysfunction: Mucosal disorders, D. Poe and Q. Gopen

Rehabilitative management of the imbalance of pressure variations in the middle ear cleft, D. Estève

Post face, P. Tran Ba Huy

Book Review

This volume represents an excellent manual exploring an entire world of problems related to "Chronic Otitis Media". Prof. B. Ars and his group of well-known otologists are moving on to explore the initial causes of the problems in order to define the factors influencing the essentials of success in the management of this chronic ear disorder.
The chapters develop in a truly organic way starting from aetiopathogenesis and moving on through the analysis of all the embryological factors up to the consequential surgical techniques and solutions.
Great emphasis is focused on the pathophysiological changes in the quality of the mucosa of the middle ear cleft, considered as the first step conditioning the development of the chronic disease.
I found this book an exhaustive manual that is going to change the mentality and the general way of thinking of surgeons managing Chronic Otitis Media.

Dott. Giovanni Danesi
ENT Department
Ospedali Riuniti di Bergamo
Italy