Yes - with an important nuance about how Wullstein himself labeled it

What is Myringostapediopexy?

Wullstein's Classification - Type III

"A classical type III or stapes columella tympanoplasty involves placement of a tympanic membrane graft such as temporalis fascia directly onto the stapes head - i.e., the ossicular chain is replaced by the single columella of the stapes."

Type III tympanoplasty (stapes columella): TM graft placed directly onto the stapes head. - Shambaugh Surgery of the Ear

The Historical Nuance - Wullstein's Own Original Labeling

"Myringostapediopexy producing a shallow middle ear and a columella effect."

Wullstein's original classification (A=Type I, B=Type II, C=Type I+II, D=Type IV, E=Type V). Panel C is what we now call Type III. - Shambaugh Surgery of the Ear

Summary

• By modern standard teaching (Wullstein classification as it is universally taught today): Yes, myringostapediopexy with a short columella graft = Type III tympanoplasty. The terms are synonymous.
• In Wullstein's original historical paper: This configuration was labeled "Type I+II" - an intermediate hybrid type, not a distinct Type III.
• The "short columella" in this context refers to the intact stapes suprastructure itself acting as the columella (as opposed to a "long columella"/TORP which goes from the footplate to the TM when the stapes arch is also absent).

• Shambaugh: Surgery of the Ear, Chapter on Tympanoplasty, Type III stapes columella section and Figure 28-1

Glomus Jugulare and Glomus Tympanicum - Shambaugh Surgery of the Ear

1. Pathology and Origin

2. Epidemiology and Genetics

• GTs arise more often in Caucasians
• Females are 4-6 times more commonly affected than males
• Peak incidence in the 5th and 6th decades, though any age is possible
• Heredofamilial tendency exists with autosomal dominant transmission
• In familial tumors, associated lesions occur in 25-50% of cases
• 10% of non-familial cases have multiple synchronous tumors
• GTs are characteristically slow-growing and rarely metastasize
• Association exists with pheochromocytoma, thyroid neoplasms, parathyroid adenoma, and MEN syndromes

3. Spread and Invasion

• 35% of jugulotympanic lesions
• 57% of intravagal paragangliomas
• CN VII through XII and the sympathetic trunk are most commonly involved

Glomus tumor extension routes - Shambaugh Surgery of the Ear, Fig. 41-8

4. Classification: Glasscock-Jackson Staging System

Glomus Tympanicum (GTy)

Glomus Jugulare (GJ)

5. Clinical Features

• Tumor growth into mesotympanum causes conductive hearing loss; labyrinthine invasion produces a sensorineural component
• TM erosion and bleeding are late symptoms
• Cranial neuropathy indicates extensive disease
• "Idiopathic" cranial neuropathy is an unacceptable diagnosis - it mandates aggressive imaging to exclude a lateral skull base lesion
• Facial paralysis is usually a late sign and an ominous omen for facial nerve outcome

6. Diagnosis and Preoperative Workup

1. Determine tumor size, type, and extent
2. Evaluate histochemical or multicentric lesions
3. Identify and assess intracranial extension
4. Assess major vasculature involvement
5. Assess intracranial collateral circulation

Imaging

• Differentiates GTy from GJ: presence of air or bone between the tumor mass and jugular bulb = GTy tumor
• Examine the caroticojugular plate (spine) separating jugular bulb from ICA - eroded early in GJ tumors; a mottled plate is characteristic for GJ tumors
• GTy: well-defined enhancing soft tissue mass over the promontory, hypotympanic floor and jugular fossa usually intact

CT showing glomus tympanicum with intact jugular bulb - Shambaugh Fig. 41-1

• Characterizes GTs by multiple vascular flow voids ("salt and pepper" appearance) on T2
• Differentiates from schwannomas (homogeneous enhancement, possible cystic areas)
• Best for evaluating ICE and neural/vascular structure involvement
• MRI of head and neck assesses multicentricity

Biochemical Screening

• Every GT patient (except small GTy) gets serum catecholamines and urinary metabolites
• Elevated epinephrine mandates adrenal CT or selective renal vein sampling to exclude pheochromocytoma
• For GTy without family history or multiplicity, biochemical screening can be omitted

7. Treatment Planning

• Patient age and physiological status
• Tumor type and natural history
• Probability the tumor causes morbidity in the patient's remaining lifespan

8. Radiation Therapy

• RT and stereotactic radiosurgery (SRS) are offered as a minimal, low-morbidity, low-cost conservation strategy
• Virtually any lesion is technically resectable; the primary criticism of surgery is the risk of functional incapacity
• The RT position: "relief of symptoms and failure of tumor to grow during the patient's lifetime is a practical measure of success" (Cummings)
• Shambaugh counters: the assumption that irradiated tumor consists of inert cells is probably inaccurate - RT forces the patient to coexist with a biologically altered tumor
• The distinction between disease "control" and "cure" is more than semantic
• Current data cannot support "disease control" because of tumor rarity, protracted 15-20 year natural history, and evolving RT techniques

9. Surgical Management

Surgical Objectives

"Total tumor removal, with the preservation of structure and function to the greatest extent possible - conservation surgery."

Preoperative Embolization

Anesthetic Goals in Lateral Skull Base Surgery

• Maintenance of hemodynamic stability (especially during tumor manipulation and catecholamine release)
• Prevention of increased intracranial pressure
• Maintenance of cerebral perfusion and oxygenation
• Facilitation of electrophysiologic monitoring
• Replacement of blood loss (autologous blood whenever possible)
• Preoperative identification and treatment of "secretors" for controlled anesthesia induction
• Postoperative airway management
• Invasive monitoring for hemodynamic data

10. Glomus Tympanicum: Surgical Management

Class I GTy - Transcanal Tympanotomy

• Performed via transcanal tympanotomy
• The mass is avulsed from the promontory
• Bleeding controlled by microbipolar coagulation or light packing
• Outpatient procedure with excellent results

Class II-IV GTy - Transmastoid Approach

• Transmastoid resection is elected
• If intraoperatively the tumor is found to be a GJ tumor (imaging unreliable), the procedure is aborted and definitive lateral skull base surgery is planned for another day
• Procedure: complete mastoidectomy with extended facial recess exposure
• Hypotympanic exposure permits visual assessment of the GTy relative to the jugular bulb, ICA, and temporal bone structures
• Inferior EAC and inferior tympanic ring are drilled substantially for adequate hypotympanic exposure; this bone is reconstructed with bone dust (pâté) collected from the cortical mastoid at the start
• Once tumor is removed, necessary tympanoplastic reconstruction is done

GTy Outcomes (Jackson Series)

• Average follow-up 55 months; average age 53 years; 91% women
• Stage I: 34%, Stage II: 52%, Stage III: 3%, Stage IV: 11%
• Extended facial recess approach used in 73%; transcanal in 16%; canal-wall-down in 11%
• Total tumor removal in 95%
• Long-term tumor control in 92.5%
• Only 2 recurrences (one at 14 years - emphasizing need for long-term follow-up: annually x5 years, then every 5 years thereafter)
• GTy associated with other paragangliomas in only 1 patient (familial history)

11. Glomus Jugulare: Surgical Management

Facial Nerve Management

Internal Carotid Artery Principles

• The ICA is fundamental to every lateral skull base case - the GT always relates to it
• The rate-limiting step in all lateral skull base surgery is dissection of tumor from the ICA
• Proximal and distal control (circumferential access to normal vessel) must be achieved - tympanic, petrous, and intracranial ICA segments all require access complementing easy neck access
• When tumor inextricably involves the ICA, continuity is restored by interpositional vein graft
• ICA sacrifice prediction testing (balloon occlusion) is not commonly done with modern vein grafting capability

GJ Class I and II (Small to Medium)

1. Patient supine; anteriorly-based neck/temporal flap incision
2. Vital neurovascular neck anatomy isolated and controlled
3. Facial nerve extratemporal dissection minimized (preserve vascular supply)
4. Internal jugular vein ligated
5. Complete mastoidectomy + mastoid tip removal + inferior tympanic bone removal + skeletonization of inferior-anterior EAC
6. Access to mesotympanum and complete dissection of tympanic ICA to the Eustachian tube for control
7. FN undergoes "short" mobilization
8. Proximal control of lateral venous sinus (LVS): achieved by intraluminal or extraluminal packing, or both. A shelf of bone is left overlying the proximal sinus for extraluminal packing between the shelf and the lateral sinus wall
   • Caution: Excessive proximal packing into the transverse sinus risks retrograde propagating thrombus with venous congestion, altered consciousness, or aphasia. Occlusion of the vein of Labbé can be fatal
9. Tumor dissected from ICA, then mobilized from the infralabyrinthine chamber
10. Within the jugular bulb, brisk bleeding from inferior petrosal sinus openings is packed gently with minimal force

GJ Class III and IV (Medium to Large)

1. Same incision as Class I-II but EAC is transected and oversewn
2. EAC, TM, and middle ear contents lateral to stapes are resected
3. Access to petrous ICA and IFTF requires anterior and inferior dislocation of the mandible by dividing anteromedial ligamentous attachments
4. FN undergoes "long" mobilization (from geniculate ganglion distally)
5. More recent modification: stylomastoid foramen contents and digastric remain attached to CN VII during translocation (reduces ICA supply risk)
6. When anterosuperior extension or distal ICA dissection is extreme: resection of zygoma and TMJ unit with inferior reflection of temporalis muscle
7. ET is resected; foramen spinosum contents managed; ICA dissected through pterygoid region to precavernous margin
8. Access extended to middle cranial fossa, nasopharynx, foramen rotundum, clivus, posterior cranial fossa, and cavernous sinus

12. Intracranial Extension (ICE)

1. Tumor dissection from ICA/IFTF
2. Tumor debulking from temporal bone down to dura
3. Removal of ICE
4. Defect reconstruction

• Wider bony and soft tissue defects
• Local tissue usually rendered unavailable for reconstruction
• CSF pressure enhanced by venous occlusion
• Regional devitalization by RT, ICA exposure, and EAC ligation ischemia

13. Defect Reconstruction

• Dural defect closed with vascularized tissue
• Tissue bulk (often vascularized) to reinforce and resist CSF pressure
• Lumbar drain for 5-7 days postoperatively for CSF decompression
• Preservation and mobilization of local tissue

14. Rehabilitation of Cranial Nerve Loss

• For small lesions: CN preservation >90%
• Single-nerve loss rarely causes clinical problems (most patients compensate)
• Acute aggregate cranial nerve loss is poorly tolerated but generally surgically rehabilitable
• In the elderly, combined CN loss may make swallowing rehabilitation impossible

• Obviated the need for tracheostomy
• Shortened hospital stay
• Reduced time to oral intake resumption
• "Revolutionized lateral skull base surgery"

15. GJ Skull Base Surgery Outcomes

• Average patient age: 41 years; 2.59:1 female predominance
• Surgical control = complete tumor removal with no recurrence
• For small lesions: CN preservation >90%
• For large tumors: CN loss is a fact of life, but compensation and operative rehabilitation are effective

Summary Table