Assoc.Prof.Dr.Murat Enöz - Primary / Revision / Ethnic / Asian Rhinoplasty and Tip Plasty in Istanbul - Ear Nose Throat Diseases, Treatment, Diagnosis and Operations
Tympanoplasty Operation in Istanbul
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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
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.
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 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 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.
Tympanoplasty Contraindications
Tympanoplasty Contraindications
Tympanoplasty operation should not be performed in the
following cases:
- Active discharge from the middle ear
- Poor general health
- 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)
Smoking is also significant negative prognostic factor for
tympanoplasty succes
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 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 is showing at the photo above. Patient was referred to our private ent office for progressive hearing loss after the tympanoplasty operation.
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.
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