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Tympanoplasty Surgery Procedure & Complications

Tympanoplasty is the surgery performed to treat eardrum perforation. A perforated eardrum can occur as a result of trauma to the eardrum. Therefore, if you’ve got a perforated eardrum, tympanoplasty may be the most suitable treatment for you. Tympanoplasty surgery involves repairing perforation using a graft or prosthesis.

 

Tympanoplasty can be classified into five types, according to the Wullstein classification.
 

Type 1: In type 1 tympanoplasty, or myringoplasty, the surgeons only repair the tympanic membrane, and do not treat any abnormality of the middle ear.

Type 2: In type 2 tympanoplasty, the surgeons repair the tympanic membrane and the middle ear. It involves grafting the tympanic membrane to the incus. 

Type 3: In type 3 tympanoplasty, the surgeons repair the tympanic membrane onto the stapes head. 

Type 4: In type 4 tympanoplasty, the surgeons graft tympanic membrane to the stapes to a movable footplate.

Type 5: This tympanoplasty involves repair with fixed stapes footplate

 

In some cases, other parts of the ear canal such as middle ear bones, etc, can also get affected due to the trauma. In such cases, the tympanoplasty surgery procedure involves extraction of all the affected parts of the ear canal, and replacing them with a graft or prosthesis. 

 

When is Tympanoplasty surgery needed?

Tympanoplasty surgery is required for treating eardrum perforation and middle ear bone trauma. This surgery becomes requisite in the following cases: 

  • Bacterial infection in the middle ear
  • Injury to the face (ear)
  • Inserting foreign items too deeply in the ear
  • Change in air pressure (barotrauma)
  • Sudden exposure to loud music
  • Contact sports
  • Deep sea diving

 

What Happens During Tympanoplasty Surgery?

Diagnosis: 

Tympanoplasty surgery is performed only after the doctors have carried out a thorough assessment of the extent of the condition and patient’s overall health. The doctors generally perform a thorough diagnosis of the patient’s condition through various diagnostic assessment, including: 

 

Physical exam: During a physical exam, the ENT doctor collects the medical history of the patients, understands the symptoms, and figures out the cause of hearing loss. He/she uses an otoscope to get a clear view of the eardrum. 

Tympanometry: In this test, the doctor assesses the eardrum’s response to air pressure. The doctor will take note of the measurements of the tympanum to examine the extent of perforation in the eardrum. 

Audiology: In this test, the doctor plays sounds at different volumes and pitches to examine the extent of the hearing loss. 

Swab test: In this test, the doctor checks for signs of ear discharge. He/she will take a sample and send it to the lab to rule out the possibility of middle-ear infections. 

Tuning fork test: In this method, the doctor uses a tuning fork to evaluate the patient's hearing ability. This two-pronged metal instrument produces sound when struck together. 
 

Tympanoplasty Procedure

Tympanoplasty surgery is typically 2 hours long, and it's performed in the following steps:

  • Before the surgery, the patient is sedated with anesthesia to ensure minimal discomfort to the patient. 
  • Once the patient is sedated, the surgeon makes an incision to reach the ear canal. Then, the surgeon uses a ‘graft’ to fill the hole.
  • The surgeon then uses a packing to keep the graft secure and in its place. 
  • In case of damage to the ossicular bone, the surgeon inserts a prosthetic in their place.
  • Finally, the patient is moved to the recovery room where he/she is kept under observation for a night. 

 

Understanding Tympanoplasty Grafts

Tympanoplasty grafts are of different types. They can be organic or synthetic. 

Organic Grafts: These grafts are usually made of cartilage, periosteum, temporalis fascia, perichondrium, vein, skin, or fat. Out of these, temporalis fascia is the most preferred graft. In case of revision surgeries, cartilage grafts are considered stronger and durable. 

Synthetic Grafts: Synthetic grafts, also known as nonautologous grafts, reduce the difficulty of graft harvesting and allow consistent wound healing. These grafts are usually selected in cases of extended trauma or in cases of ossicular damage. 
 

How To Prepare For Tympanoplasty Surgery?

Preparation is generally the first step toward ensuring a successful tympanoplasty surgery. Since this is an invasive procedure, being prepared will help you remain relaxed during the surgery. So, on that note, here are some ways in which you can prepare for your tympanoplasty surgery: 

  1. Patients need to have all their doubts cleared before the surgery. The surgeon will explain the entire tympanoplasty procedure to you. Make sure you also get all your questions answered.
  2. Inform your doctor about the medicines and supplements that you take on a regular basis. Also, inform the doctor about your surgeries.
  3. If your child is getting the surgery done, make sure you make your child aware of the surgery procedure.
  4. Wear loose and comfortable clothing on the day of surgery. Also, avoid wearing jewelry to the hospital. 
  5. Do not smoke for at least 2 to 3 weeks before the surgery. Smoking can adversely affect your recovery. Additionally, ask the doctor for the dietary changes that you need to make.

 

How To Recover After Tympanoplasty? 

The total recovery period after tympanoplasty is about 2 to 3 months. However, the patients can resume their work within 1 to 2 weeks of the surgery. The patient can experience minor bleeding and drainage in the initial days after the surgery, but it generally stops in 3 to 5 days. Doctors remove the stitches within a week after the surgery. Listed below are some tips that can help you recover quickly after your tympanoplasty surgery: 

  • Use pillows to keep your head elevated. This will help you in reducing swelling.
  • Prevent water from entering your ear. Use a dry cotton ball to clean the area around the surgical site. 
  • Avoid strenuous activities, heavy exercise, and weightlifting. Also, avoid contact sports for a couple of weeks after the surgery. 
  • Avoid flying or swimming without taking approval from your doctor. 

 

What Tympanoplasty Complications Can Occur After Surgery?

Tympanoplasty is a safe procedure and the success rate is quite high. In most cases, this surgery does not cause any complications, and the patients comfortably resume their daily activities. However, in some cases, tympanoplasty complications can occur. Some common complications associated with tympanoplasty surgery, include: 

  • Bleeding and infection

  • Dizziness

  • Failure of graft

  • Failure to reverse hearing loss

  • Ringing in the ears (tinnitus)

  • Strange taste in the mouth

The risk of complications is quite low in this surgery. However, if you experience any of the above mentioned complications, along with high fever or excruciating pain after the surgery, make sure you consult your ENT doctor immediately. 
 

How To Prevent Eardrum Perforation?

As discussed, a ruptured or perforated eardrum can occur due to various factors, and almost always requires tympanoplasty. However, some tips can help you protect your eardrum in the first place. Here’s how you can protect your eardrum from getting ruptured: 

  • If you have an ear infection, get it treated in time.

  • Do not insert foreign objects in your ear.

  • If you are expecting a pressure change due to a flight, scuba diving, etc, take measures to protect your ears. 

  • Clean your ears carefully. Avoid using cotton swabs, hairpins, paper clips, etc/ These objects can easily rupture the eardrum. 

  • Keep your ears protected against loud sounds.

  • Wear protective earplugs or earmuffs if you are expecting a shock or trauma to your eardrums.

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