Tympanoplasty - Repairing the Ear Drum

The ear is described as having three parts - the outer ear, middle ear and the inner ear. Tympanoplasty is the surgery performed to repair the perforated ear drum (tympanic membrane) or the small bones of the middle ear (ossicles). "Perforated ear drum" or "tympanic membrane eardrum" is a hole in the tissue that separates the ear canal from ear drum (middle ear). This may result from the chronic infection or trauma of the eardrum.

When a sound is made, the sound waves, or vibrations, travel down the external auditory canal and strike the eardrum (tympanic membrane). The eardrum vibrates. The ossicles amplify the sound and send the sound waves to the inner ear and into the fluid-filled hearing organ (cochlea).

Signs of a perforated eardrum include:

• Hearing loss
• Earache
• Itching in your ear
• Fluid leaking from your ear
• A high temperature (fever)
• Ringing or buzzing in your ear (tinnitus)

Usually, small perforations heal within a few weeks and might not require any treatment. But, in case of the larger perforations the spontaneous repair may be hindered due to low blood supply or an infection. So, it is good to see your ENT physician if you think your eardrum has perforation. The physician looks into your ear using a small, hand-held torch with a magnifying lens. Your physician may prescribe antibiotic drops if there is an evidence of infection. If the tear or hole in the eardrum doesn't heal by itself, any of the following procedures are used to close the perforation.

Eardrum patch: If the tear or hole in the ear drum doesn't close by itself, your ENT physician seals it using a patch.

Surgery: Surgery is recommended when the patch doesn't result in proper healing or when your ENT physician determines that the tear is not likely to heal with the patch. The surgical procedure is called "tympanoplasty".

TYPES OF TYMPANOPLASTY

Tympanoplasty is an outpatient procedure in which the physician grafts a tiny patch of your own tissue to close the hole in the eardrum. Tympanoplasty is classified into five types:

• Type I tympanoplasty (myringoplasty): It involves the repair of the perforated eardrum alone by grafting.
• Type II tympanoplasty: It is indicated for tympanic membrane perforations with erosion of the small bones of middle ear (ossicles).
• Type III tympanoplasty: It is indicated when the middle ear bones (ossicles) are destructed. It involves placing a graft onto the stapes, and providing protection for the assembly.
• Type IV tympanoplasty: It is used for ossicular destruction, which includes all or part of the stapes arch. It involves placing a graft onto or around a mobile stapes footplate.
• Type V tympanoplasty: It is used when the footplate of the stapes is fixed.

Tympanoplasty can be done by taking an incision behind the ear, in front of the ear or through the ear canal which is rarely visible. The most common grafts used to repair the ear drum are:

• Temporalis fascia
• Tragal or conchal cartilage
• Vein graft
• Canal skin
• Homograft TM

Tympanoplasty in children is considered less successful than adults. General complications of tympanoplasty include :

• Infection
• Graft failure
• Chondritis
• Injury to the nerve (chorda tympani)
• Sensorineural hearing loss (SNHL) and vertigo
• Increased conductive hearing loss
• External auditory canal stenosis

SURGERY

PRE-OPERATIVE DETAILS

Evaluation of detailed patient history and physical examination is done. Before considering the surgery option for any patient, acute and chronic infections are controlled using ototopical, oral, intravenous antibiotics or antifungals. Ideally, an ear should be "dry" for 3-4 months before surgery is performed to improve the chance of success. Surgery is contraindicated in patients with infected ear.

INTRA-OPERATIVE DETAILS

During the surgery, the area for surgery is marked to make sure there are no errors. Anesthesia provider will keep you comfortable and safe either by giving local anaesthesia (causes numbness in a specific part of the body) or general anaesthesia (make you unconscious). The surgery will take about 1 to 3 hours. Your physician places foam packing or ointment in your ear canal which will be taken out after 1 to 2 weeks of surgery.

POST-OPERATIVE DETAILS

Individuals who undergo surgery are instructed to keep the operated ear dry for a period of several weeks or until the graft has healed. All the activities that increase the blood pressure in head area such as bending over and lifting heavy objects should be avoided. You should not blow your nose for three weeks.

Excessive coughing and sneezing should be avoided and try to let the sneeze come out of mouth as cough. Swimming, gym, athlete activities, diving, flying in an airplane and water skiing should be avoided for two months after surgery. On an average a patient is usually able to resume to normalcy in one to two weeks following the surgery. After a simple tympanoplasty, most patients may resume activities in a week's time.

WHY CHOOSE BSR HOSPITAL FOR TYMPANOPLASTY?

BSR ENT hospital is well-known by the team of expert and experienced surgeons with a proven track record of successful surgeries. It has done successful surgeries in the past 40 years. The experienced and highly qualified doctors at BSR are skilled to provide the best treatment to the patients.

The latest technologies and the equipment further support the vision of BSR to provide the best in class treatment facilities to patients. We, at BSR believe in patient-centric treatment and ensure that every patient receives the quality treatment at affordable price.