Tympanoplasty Operation in Istanbul

Tympanoplasty Operation

Tympanoplasty Operation
A tympanoplasty is a surgical procedure which generally used to repair a ruptured eardrum but sometimes involves the repair of the ossicles in middle ear (myringoplasty, the eardrum surgery is the name given to the closure of small holes in eadrum.  When myringoplasty is combined with ossicular reconstruction, it is called tympanoplasty).    

The aim of the eardrum surgeries (tympanoplasty / myringoplasty):

- Prevent recurrent ear infections.

- Improve hearing, if there is a conductive hearing loss due to eardrum perforation.

- Enable patients to swim or get ear wet without facing infection as a consequence. 

Tympanic Membran Perforation - A Hole In The Eardrum

Tympanoplasty Operation - Tympanoplasty Animation - Repair of Tympanic Membran Perforation - Transcanal (Transmeatal, Endomeatal) Tympanoplasty - A Hole In The Eardrum - Myringoplasty Technique - Tympanoplasty Indications - Tympanoplasty Contraindications - Postoperative Patient Care For Tympanoplasty Operation - Post-operative Instructions for Tympanoplasty
Tympanic membrane perforation defined as hole or tear in ear drum. This problem can cause to hearing loss and deterioration of barrier function of ear drum.

Perforations without infection or cholesteatoma are not painful. The patient may report audible whistling sounds during sneezing and nose blowing, decreased hearing, and a tendency to infection during colds and when water enters the ear canal. Perforation with infection typically results in copious purulent drainage, which may be sanguineous in both acute and chronic perforation. Surgeries to treat the eardrum (tympanoplasty or myringoplasty) can made according to perforation dimension and middle ear state.

A perforated eardrum, also known as a tympanic membrane perforation, is a tear or hole in the thin membrane that separates the ear canal from the middle ear. This condition can have several health effects, including:

Hearing Loss: One of the most common effects of a perforated eardrum is hearing loss. The severity of hearing loss can vary depending on the size and location of the perforation. Sound may not be transmitted effectively to the middle ear, leading to decreased hearing acuity.

Ear Infections: A perforated eardrum can increase the risk of ear infections. The middle ear is normally protected from external contaminants by the intact eardrum. When the eardrum is perforated, bacteria and viruses can more easily enter the middle ear, potentially leading to recurrent infections.

Tinnitus: Some individuals with a perforated eardrum may experience tinnitus, a ringing, buzzing, or other noises in the ear. This is often associated with hearing loss and the disruption of normal sound transmission in the ear.

Vertigo and Balance Issues: In some cases, a perforated eardrum can lead to balance problems and vertigo. The inner ear plays a crucial role in balance, and changes in pressure or fluid balance due to the perforation can affect the inner ear, leading to dizziness and a sensation of spinning.

Pain and Discomfort: A perforated eardrum can be painful, especially if it is caused by trauma or infection. Pain is often more prominent when the injury or infection is fresh, but it can persist in some cases.

Sensitivity to Loud Noises: People with a perforated eardrum may be more sensitive to loud noises (hyperacusis) because the normal protective function of the eardrum is compromised.

It's important to note that not all perforated eardrums are the same, and the effects can vary widely depending on factors such as the size of the perforation, the cause of the perforation, and individual differences. Some small perforations may heal on their own, while others may require medical intervention. In some cases, surgical repair may be necessary to restore hearing and prevent further complications.

If you suspect you have a perforated eardrum or are experiencing any of the associated health effects, it is crucial to seek medical attention. A healthcare provider or an ear, nose, and throat specialist can diagnose the condition and recommend appropriate treatment based on the specific circumstances.

Animation of Tympanoplasty Operation

Animation of Tympanoplasty Operation
Various techniques and grafting materials can be used in tympmanoplasty procedure. Which approach is used depends on the size and location of the perforation with middle ear condition.

 Tympanoplasty technique and grafting materials can be changed by the following factors:

- The presence or absence of cholesteatoma or granulation tissue
- The status of the ossicles and mastoid, other anatomical considerations (eg, narrow external auditory canals)
- The surgeon’s preference and expertise.

Tympanoplasty is a surgical procedure used to repair a perforated or damaged eardrum, which is also known as the tympanic membrane. This procedure is typically performed by an otolaryngologist (ear, nose, and throat specialist) and can help restore hearing, prevent ear infections, and alleviate related symptoms. Here is an overview of the tympanoplasty operation:


Anesthesia: Tympanoplasty can be performed under local or general anesthesia, depending on the specific case and the patient's age and medical condition.

Incision: The surgeon makes an incision behind or inside the ear to access the middle ear.

Exposure of the Tympanic Membrane: The surgeon carefully exposes the tympanic membrane and examines the extent of the perforation or damage.

Graft Material: To repair the perforation, the surgeon may use graft material, which can be taken from the patient's own tissue (such as a small piece of tissue from behind the ear) or a synthetic material. The choice of graft material depends on various factors, including the size and location of the perforation.

Tympanic Membrane Repair: The graft material is placed over the perforation and secured in position. The surgeon may use small sutures to hold the graft in place.

Tympanoplasty Variations:

Myringoplasty: This is a simpler form of tympanoplasty that involves repairing a small hole or tear in the eardrum without addressing the middle ear's ossicles (tiny bones involved in hearing).

Closure: After the graft is secured, the incision is closed with sutures.

Dressing: In some cases, a sterile dressing may be placed over the ear to protect it during the healing process.

Tympanoplasty is classified into five different types, originally described by Wullstein.

1. Type 1 involves repair of the tympanic membrane alone, when the middle ear is normal (this type is synonymous to myringoplasty).
2. Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in the middle ear ossicles.
3. Type 3 involves removal of ossicles and epitympanum when there are large defects of the malleus and incus. The tympanic membrane is repaired and directly connected to the head of the stapes.
4. Type 4 describes a repair when the stapes foot plate is movable, but the crura are missing. The resulting middle ear will only consist of the Eustachian tube and hypotympanum.
5. Type 5 is a repair involving a fixed stapes footplate.
Temporalis fascia, tragal cartilage with perichondrium are most commonly used graft materials.

Transcanal (Transmeatal, Endomeatal) Approach

The transcanal approach is especially good for small posterior perforations, but can be used for medium-sized perforations if the anterior tympanic membrane is easily visualized. This technique can be challenging for significant anterior perforations, narrow / stenotic ear canals, or individuals with a significant anterior canal bulge.

Endaural Approach

The endaural technique is useful with many perforations, especially when a small atticotomy is anticipated (when improved access to and visualization of the epitympanum is needed). Many of the steps involved in the transcanal technique are similarly performed in the endaural tympanoplasty as well.

Postauricular Approach

The postauricular technique is the most commonly performed approach for either revision tympanoplasties or those in which a mastoidectomy is anticipated. This technique offers the best visualization of the anterior tympanic membrane and is preferred for large anterior perforations. In addition, it can be combined with mastoidectomy if disease is found in the mastoid that requires the surgeon’s attention.

Animated images descriptions:

- Dead fibrotic layer is removed from the edges of perforation
- Rosen incision is made
- Tympanomeatal flap is elevated
- Fascia is placed as underlay
- The flap is laid back
- The operation operation is terminated after the placing of sponges.

Tympanoplasty Indications

Tympanoplasty Indications

Tympanoplasty operation should be sutable in the following cases:
- Central and dry ear drum perforation
- Dry tympanic mebrane perforations (either central or marginal)
Tympanoplasty can be combined with mastoidectomy and ossiculoplasty.

This procedure is performed to address various medical conditions and situations. The main indications for tympanoplasty include:
  • Tympanic Membrane Perforation: The most common indication for tympanoplasty is a perforated eardrum. Perforations can occur for various reasons, such as:
  1. Chronic ear infections (otitis media with perforation)
  2. Trauma to the ear, including injury or a sudden change in air pressure
  3. Prolonged exposure to loud noises
  4. Foreign objects inserted into the ear
  5. Inflammation or irritation from chronic earwax removal
  6. Chronic Otitis Media: Tympanoplasty may be recommended for individuals with chronic otitis media (middle ear infections that persist for an extended period) when other treatments, such as antibiotic therapy or ear drops, have been ineffective.
  • Hearing Loss: Tympanoplasty can help improve hearing when hearing loss is associated with a perforated eardrum. The procedure aims to restore the integrity of the eardrum, allowing sound to be transmitted effectively to the middle ear.
  • Prevention of Ear Infections: Individuals who experience recurrent ear infections due to eardrum perforations may undergo tympanoplasty to reduce the risk of further infections and their associated complications.
  • Middle Ear Problems: In some cases, tympanoplasty may be combined with the repair or reconstruction of the middle ear structures, such as the ossicles (tiny bones that transmit sound) or the ear's drainage system (eustachian tube). This is often referred to as a type II or type III tympanoplasty.
  • Aural Atresia: Tympanoplasty can also be considered in cases of aural atresia, a congenital condition in which the ear canal does not fully develop. The procedure can help establish an ear canal and eardrum to improve hearing.
The specific type of tympanoplasty performed may vary depending on the size and location of the perforation, the presence of other ear-related problems, and the overall health of the patient. Tympanoplasty is typically recommended after a thorough evaluation by an ear, nose, and throat specialist (otolaryngologist) who will assess the patient's medical history, conduct a physical examination, and may perform hearing tests and imaging studies to determine the most appropriate course of treatment.

It's important for individuals with ear-related problems to seek medical advice from a qualified healthcare professional to determine if tympanoplasty is an appropriate treatment option for their specific condition.

Tympanoplasty Contraindications

Tympanoplasty Contraindications

While it is a safe and effective procedure for many individuals, there are some contraindications and situations in which tympanoplasty may not be recommended. Tympanoplasty operation should not be performed in the following cases:

- Active Ear Infections: Tympanoplasty is typically not performed when an individual has an active ear infection, as it can increase the risk of complications and hinder the healing process. The infection needs to be adequately treated and resolved before the surgery can be considered.

- Uncontrolled cholesteatoma

- Malignant tumors of middle / external ear

- Uncontrolled nasal allergy

- When the other ear is dead (deaf ear)

- Patients with less than 3 years of age (generally tympanoplasty perform after the age of 8-10 years old)

- Uncontrolled Medical Conditions: Individuals with uncontrolled medical conditions, such as uncontrolled diabetes or hypertension, may not be suitable candidates for surgery. These conditions can increase the risk of surgical complications and impair the healing process.

- Immunocompromised Individuals: People with compromised immune systems due to medical conditions, immunosuppressive medications, or other factors may be at a higher risk of postoperative infections and may not be considered good candidates for surgery.

- Active Allergies: Individuals with severe allergies or sensitivities may be at increased risk of allergic reactions to surgical materials or medications used during the procedure.

- Severe Middle Ear Disease: In some cases of extensive or advanced middle ear disease, such as cholesteatoma (an abnormal skin growth in the middle ear), additional treatment or a different surgical approach may be required instead of tympanoplasty.

- Medical Unfitness for General Anesthesia: If a patient is deemed medically unfit for general anesthesia due to underlying health issues, tympanoplasty may not be recommended. Anesthesia is often used during the procedure, and the patient's overall health should support this.

- Inadequate Evaluation and Diagnosis: Tympanoplasty should only be considered after a comprehensive evaluation by an ear, nose, and throat specialist (otolaryngologist). The specialist will assess the patient's medical history, conduct a physical examination, and perform relevant tests, including hearing assessments and imaging studies. If there is uncertainty about the diagnosis or the appropriateness of the surgery, further evaluation may be necessary.

- Patient Preferences and Expectations: Tympanoplasty is typically performed to improve hearing and address specific medical conditions. If a patient's primary motivation is cosmetic or purely aesthetic, the surgery may not be recommended.

It's important to note that the suitability for tympanoplasty is assessed on an individual basis. The decision to undergo the procedure is made after careful consideration of the patient's medical history, overall health, specific ear condition, and their informed consent. Patients should consult with an otolaryngologist to discuss their options and determine the best course of treatment based on their unique circumstances.

The Failed Ear Drum Surgery (Myringoplasty or Tympanoplasty) Photos

Tympanoplasty Contraindications

However, sometimes infection, trauma or lack of surgical technique can cause graft failure and therefore failure to heal the eardrum.

Photo above at the posterior of the ear drum, the graft is immediately adjacent to the hole. Patient admitted to us for solving this problem.

Retraction pocket at the posterior quadrent of eardrum

Retraction pocket at the posterior quadrent of eardrum after the tympanoplasty operation is showing at the photo above. Fascia was used for closing of perforation and retracted. This patient referred to us for solving hearing loss problem.

Posterior retraction pocket after the cartilage tympanoplasty

Posterior retraction pocket after the cartilage tympanoplasty is showing at the photo above. Patient was referred to our private ent office for progressive hearing loss after the tympanoplasty operation.

A retraction pocket can occur after cartilage tympanoplasty, which is a surgical procedure to repair a perforated eardrum using a graft of cartilage. A retraction pocket is a condition in which a portion of the eardrum, or the entire eardrum, is pulled inward or retracted into the middle ear space. This condition can occur as a complication following tympanoplasty, and it may have several potential causes and consequences:


Tissue Healing: The graft used to repair the perforated eardrum may not heal uniformly, leading to areas of the eardrum being pulled inward.

Scarring: Excessive or abnormal scarring in the middle ear can lead to retraction pockets.

Negative Middle Ear Pressure: Negative pressure within the middle ear can create a vacuum effect, causing the eardrum to be pulled inward.


Hearing Loss: A retraction pocket can affect the movement of the middle ear bones (ossicles) or restrict the normal vibration of the eardrum. This can lead to hearing loss.

Ear Infections: Retracted portions of the eardrum may collect debris or fluids, which can increase the risk of ear infections.

Tinnitus: Some individuals with retraction pockets may experience tinnitus, which is a ringing or buzzing in the ear.

Further Damage: In some cases, retraction pockets can lead to further damage to the middle ear structures or the eardrum.


The management of a retraction pocket following cartilage tympanoplasty can vary depending on the size and severity of the retraction, the presence of symptoms, and the patient's overall health. Treatment options may include:

Observation: In some cases, small and asymptomatic retraction pockets may be closely monitored without immediate intervention. Regular check-ups with an ear specialist are important to ensure that the retraction does not worsen.

Ventilation Tubes: The placement of ventilation tubes (tympanostomy tubes) in the eardrum may be considered to equalize middle ear pressure and prevent further retraction.

Surgical Correction: For more severe cases or when complications arise, additional surgery may be needed to correct the retraction and restore normal eardrum anatomy. Surgical options may include tympanoplasty revision or other middle ear procedures.

It's important for individuals with retraction pockets or concerns following cartilage tympanoplasty to seek medical advice from an ear, nose, and throat specialist (otolaryngologist). The specialist can evaluate the condition, discuss the treatment options, and recommend the most appropriate course of action based on the specific circumstances. Early intervention is often important to prevent further complications and to address hearing and ear health concerns.

Cost of Tympanoplasty Operation in Istanbul

Link to the article you can read to learn about the cost of tympanoplasty and other eardrum surgeries in Istanbul >> Cost of Eardrum Hole Surgery in Istanbul (ent-istanbul.com)

Postoperative Patient Care For Tympanoplasty Operation

Postoperative Patient Care For Tympanoplasty Operation

- Do not blow your nose until your physician has indicated that your ear is healed. Any accumulated secretions in the nose may be drawn back into the throat and expectorated if desired. This is particularly important if you develop a cold.
- Do not “pop” your ears by holding your nose and blowing air through the eustachian tube into the ear. If it is necessary to sneeze, do so with your mouth open.

- Do not allow water to enter the ear until advised by your physician that the ear is healed. Until such time, when showering or washing your hair, lamb’s wool or cotton may be placed in the outer ear opening and covered with Vaseline.

- If an incision was made in the skin behind your ear, water should be kept away from this area for 1 week.

- Do not take an unnecessary chance of catching cold. Avoid undue exposure or fatigue. Should you catch a cold, treat it in your usual way, reporting to your doctor.

- For avoiding constipation to eat foods of high in fiber and walking may be useful.

- Patients typically experience some discomfort, hearing improvement, and a sense of fullness in the ear during the recovery period.

- The ear may be bandaged, and patients may be instructed to keep the ear dry during the initial healing phase.
- Follow-up appointments are important to monitor the healing process.
 Full recovery may take several weeks to months.

- Tympanoplasty is generally considered a safe and effective procedure with a high success rate, but the outcome can vary depending on factors such as the size and location of the perforation and the patient's overall health. The goal of the surgery is to restore hearing and prevent recurrent ear infections. It's essential to follow your surgeon's post-operative instructions carefully to optimize your chances of a successful outcome.

​Endoscopic Eardrum Repair in Istanbul

Endoscopic eardrum repair, also known as endoscopic tympanoplasty, is a minimally invasive surgical procedure used to repair a perforated or damaged eardrum (tympanic membrane) or to address other middle ear issues. This technique offers several advantages over traditional open eardrum repair procedures, such as a smaller incision and potentially faster recovery. Here's an overview of endoscopic eardrum repair:


Anesthesia: The procedure is usually performed under local or general anesthesia, depending on the patient's preference and the surgeon's recommendation.

Endoscope Insertion: The surgeon inserts a thin, flexible endoscope into the ear canal, allowing for a magnified view of the eardrum and middle ear structures. The endoscope has a light source and a camera on the tip, providing a clear visual of the surgical area.

Visualization: The surgeon examines the eardrum and any middle ear issues, such as ossicle damage or disease. This real-time visualization helps the surgeon accurately assess the condition.

Tympanic Membrane Repair: If a perforation is present, the surgeon may use specialized tools and instruments to clean the edges of the perforation and remove any scar tissue.

Graft Placement: The surgeon may use graft material, typically taken from the patient's own tissues or a synthetic material, to cover the perforation. The graft is positioned to restore the eardrum's integrity.

Closure: After the graft is securely in place, the surgeon may use small clips, glue, or sutures to ensure that it stays in position. The incision or access point in the ear canal is then closed.

Ventilation Tube Insertion: In some cases, ventilation tubes (tympanostomy tubes) may be placed in the eardrum to equalize middle ear pressure and prevent retraction or recurrent perforations.

Recovery and Aftercare:

Recovery after endoscopic eardrum repair is generally quicker compared to traditional open procedures. Patients often experience less pain and a shorter hospital stay.

There may be some mild discomfort, ear fullness, or drainage from the ear immediately after surgery, but these symptoms typically resolve within a few days.

Follow-up appointments are crucial to monitor the healing process and assess hearing improvement.
Patients are usually advised to avoid water in the ear and to follow specific postoperative care instructions provided by their surgeon.

Endoscopic eardrum repair is considered a safe and effective technique for many patients, but the suitability for the procedure is determined on an individual basis. The choice of surgical technique (endoscopic or open) and the graft material used depend on factors such as the size and location of the perforation, the presence of other middle ear issues, and the surgeon's experience and preference.

Patients with ear-related concerns or perforated eardrums should consult with an ear, nose, and throat specialist (otolaryngologist) to discuss their treatment options and determine the most appropriate course of action based on their specific condition.

The search result link you can click to read the articles about eardrum perforation that I have previously prepared on this website >> https://www.ent-istanbul.com/search?q=eardrum+perforation

Source links:

  • Tympanoplasty - eMedicine World Medical Library - Medscape

  • Eardrum repair: MedlinePlus Medical Encyclopedia

  • Tympanoplasty - Home Care Instructions

  • tympanoplasty surgery - Mayo Clinic

  • Over-under tympanoplasty.

  • Tympanoplasty/*methods - Books, Journals and Healthcare ...

  • Side Effects of a Tympanoplasty | LIVESTRONG.COM

    Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

    Private Office:
    Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
    Appointment Phone: +90 212 561 00 52
    E-Mail: muratenoz@gmail.com
    Mobile phone: +90 533 6550199
    Fax: +90 212 542 74 47