In our institute we come across many patients with adhesive otitis media in which the main pathology lies in the Eustachian tube as a result of which the middle ear cavity is virtually replaced by masses of scar tissue and air space is obliterated .Adhesions are commonest in the posterior part of mesotympanum and in the attic. The adhesion consists of dense mature fibrous tissue covered by an intact investing epithelium. To recreate the middle ear space the adhesions are carefully divided and scar tissue mass excised, a silastic film is placed in the middle ear to prevent adhesion formation during the healing phase .We also use Inj.Kenacort into the middle ear mucosa with the same aim. We have also placed silastic in cases of tympanosclerosis following removal of the plaque to prevent adhesions.

We also place silastic film in revision mastoidotympanoplasty in which there is adhesion between the tympanic membrane and the middle ear and we fashion the silastic film in such a way so that there is air around the round window membrane which improves the hearing results, in addition the middle ear space is maintained and aeration of the mastoid is done. The silastic tends to get extruded wherever it touches the neotympanum and hence contact of this material and TM graft is avoided. We also reinforce the temporalis fascia graft with perichondrium to prevent its extrusion.