Tympanoplasty

Diagram of a tympanoplasty procedure

Tympanoplasty is a surgical procedure designed to reconstruct the tympanic membrane, commonly known as the eardrum, and sometimes the small bones of the middle ear. This procedure is typically performed to repair a perforation in the eardrum, improve hearing, and prevent recurrent ear infections.

Indications

Tympanoplasty is indicated in patients with chronic otitis media with perforation, traumatic perforations of the eardrum, and in some cases of cholesteatoma. The goal of the surgery is to close the perforation, eradicate disease, and restore hearing.

Types of Tympanoplasty

Tympanoplasty can be classified into different types based on the extent of the repair and the structures involved:

Type I Tympanoplasty

Also known as myringoplasty, this involves the repair of the tympanic membrane alone without any involvement of the ossicular chain.

Type II Tympanoplasty

This type involves repair of the tympanic membrane and the malleus, with the graft placed onto the incus or the stapes.

Type III Tympanoplasty

In this procedure, the tympanic membrane is repaired and the graft is placed onto the stapes head, often used when the incus is absent or eroded.

Type IV Tympanoplasty

This involves placing the graft onto the footplate of the stapes, used when the stapes superstructure is absent.

Type V Tympanoplasty

This is a more complex procedure involving fenestration of the horizontal semicircular canal, rarely performed today.

Surgical Techniques

The surgical approach to tympanoplasty can vary, but common techniques include:

Underlay Technique

In this technique, the graft material is placed medial to the remaining tympanic membrane and the ossicular chain.

Overlay Technique

Here, the graft is placed lateral to the tympanic membrane remnant, often used in cases with anterior perforations.

Postoperative Care

After tympanoplasty, patients are advised to avoid water entry into the ear, refrain from nose blowing, and avoid upper respiratory infections. Follow-up visits are necessary to monitor healing and assess hearing improvement.

Complications

Potential complications of tympanoplasty include graft failure, infection, hearing loss, tinnitus, and dizziness. However, with advances in surgical techniques, the success rate of tympanoplasty is high.

Related pages

• Otosclerosis
• Mastoidectomy
• Cochlear implant