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Complete guide on Tympanoplasty

  • Posted on- Jan 06, 2018
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What are the causes of tympanoplasty?Tympanoplasty can be defined as the surgery performed by surgeons who deal with ear for the repairment of incision in the eardrum. There are several different types of tympanoplasty and the exact one is chosen based on patient age, the cause of the hole, location, size of the hole and if previous surgery has been attempted.

Under local and general anesthesia, a reconstruction surgery can be performed.

Many patients prefer to be completely asleep, In small perforations, the operation can be easily performed under local anesthesia with intravenous sedation. An incision is made into the ear canal and the remaining eardrum is elevated away from the bony ear canal and lifted forward.

What is the procedure of tympanoplasty?



Classification of Tympanoplasty:



  • Type I: Defect in the tympanic membrane (Eardrum) is repaired by the graft after checking the mobility and status of the ossicular chain.
  • Type II: There is a perforation with erosion of the malleus or part of incus
  • Type II a: Graft is kept touching the malleus remnant, incus or incudostapedial joint.
  • Type II b: Here the incus is also diseased. The body of the incus is refashioned to fit into the stapes head. The short process of incus goes under the handle of malleus. The ossicular chain is covered by a graft.
  • Type III: Malleus and incus are absent
  • Type III a: Low facial ridge: Graft is kept below the level of malleus touching the stapes head, called myringostapediopexy.
  • Type III b: High facial ridge: below the malleus graft are touching not directly touching the stapes.
  • Type IV: Graft kept on the foot plate after separating the round window. Sound waves directly act on the footplate.
  • Type V: Sound waves enter through a fistula into the lateral semicircular canal.
  • Type VI: Sono- Inversion: All sound waves enter through the round window keeping the oval window covered.

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 eardrum are:

  • Temporalis fascia
  • Tragal or conchal cartilage
  • Vein Graft

What are the causes of tympanoplasty?



The causes of perforated eardrum are usually from trauma or infection. A perforated eardrum can occur:
  • If a square opening is held by hand in the ear.
  • With a skull fracture
  • After sudden explosions
  • If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal.
  • Infections in the Middle ear may cause pain, hearing loss and spontaneous rupture (tear) of the ear-drum resulting in a perforation. Due to some complication can cause some infected or blood flow from the ear. In medical terms, this is called otitis media with perforation.
  • In some case, a small hole can be felt in eardrum after placing a PE tube which falls out or is removed by the physician.
  • Some of the ear surgery heals up within the week after, although some may take up to several months. Perforation present in the ear if not heel by self then there may be a surgery required.

What is the effect of tympanoplasty?



Usually, the larger the perforation, the greater the loss of hearing. The location of the hole (perforation) in the eardrum also affects the degree of hearing loss. If severe trauma (e.g. skull fracture) disturbs the bones at the middle ear which processes the sound or makes an injury inside the ear geographia, the loss of hearing may be quite severe.
 
In case perforated eardrum causes an unwanted trauma or blasting case then, the loss of hearing can be great and ringing in the ear (tinnitus) may be severe. In this kind of cases, the hearing returns usually. These hearing cases usually come back minimally and the sound vanishes in few seconds. Chronic infection as a result of the perforation can cause major hearing loss.

 
What are the risks of tympanoplasty?



Some visible complication inculcates dullness of the graft to heal, causing recurrent eardrum perforation, narrowing of the ear, canal scarring or adhesions in the middle ear per lymph fistula and hearing loss erosion or extrusion of the prosthesis dislocation of the prosthesis and facial nerve injury. Various problems such as an occurrence of cholesteatoma won’t result from the surgery.
 
Perforation in the ear can cause various kinds of noises in the ear. Usually, with improvement in hearing and closure of the eardrum, the tinnitus resolves. In most of the cases, the case becomes worse after the operation. In rare cases, tinnitus becomes permanent after surgery.

Minimum cost of Tympanoplasty is Rs.1,50,000 to maximum Rs.3,00,000.

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