Tympanoplasty

Surgical procedure to reconstruct the eardrum

Diagram of a tympanoplasty procedure

Tympanoplasty is a surgical procedure designed to reconstruct a perforated tympanic membrane (eardrum) or the small bones of the middle ear. This procedure is often performed to improve hearing or to prevent recurrent ear infections.

History

The development of tympanoplasty can be traced back to the early 20th century. The procedure has evolved significantly with advancements in surgical techniques and materials. Early attempts at eardrum repair were rudimentary, but modern tympanoplasty techniques have become highly sophisticated, allowing for improved outcomes.

Indications

Tympanoplasty is indicated in patients with chronic otitis media with perforation, traumatic perforations of the eardrum, or cholesteatoma. It is also performed to restore hearing in cases where the ossicular chain is disrupted.

Types of Tympanoplasty

There are several types of tympanoplasty, classified based on the extent of the repair:

• Type I Tympanoplasty (Myringoplasty): Involves the repair of the eardrum alone.
• Type II Tympanoplasty: Involves repair of the eardrum and the malleus.
• Type III Tympanoplasty: Involves repair of the eardrum and the incus.
• Type IV Tympanoplasty: Involves repair of the eardrum with stapes superstructure intact.
• Type V Tympanoplasty: Involves repair with a fenestration in the horizontal semicircular canal.

Surgical Technique

The procedure is typically performed under general anesthesia. The surgeon may use a microscope to gain a better view of the middle ear structures. A graft, often taken from the patient's own tissue such as the temporalis fascia, is used to close the perforation. The approach can be through the ear canal (transcanal) or through an incision behind the ear (postauricular).

Recovery and Prognosis

Recovery from tympanoplasty varies depending on the extent of the surgery. Patients are usually advised to avoid water in the ear and refrain from activities that may increase ear pressure, such as flying or diving, for several weeks. The success rate of tympanoplasty is high, with most patients experiencing significant improvement in hearing and a reduction in ear infections.

Complications

While tympanoplasty is generally safe, potential complications include infection, bleeding, dizziness, tinnitus, and, in rare cases, hearing loss. The risk of complications is minimized with proper surgical technique and postoperative care.

Related pages

• Otitis media
• Cholesteatoma
• Otosclerosis