Tympanoplasty Operation in Istanbul

Tympanoplasty Operation

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. 

You can see my last detailed article about this subject at >> ​Ear Drum Repair / Perforated Eardrum - Definition, Causes, Symptoms, Treatment / Myringoplasty Operation

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.

Animation of Tympanoplasty Operation

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 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 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
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.

Postoperative Patient Care For 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.

​Endoscopic Eardrum Repair in Istanbul

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


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