Tympanoplasty Surgery

What is tympanoplasty surgery?

“Tympanoplasty” surgery, applied in chronic middle ear problems is technically the cleaning of the inflammation in the middle ear and mastoid bone and repairing of the auditory system in the tympanic membrane (eardrum) and the middle ear. 

The surgery may be performed just to repair the hole in the eardrum (myringoplasty), to repair the eardrum in addition to the bone system providing the sound transmission (tympanoplasty), to clean the inflammation that is progressed into mastoid bone (mastoidectomy) or may be the combination of all these operations (tympanomastoidectomy).

When is tympanoplasty surgery performed?

In situations, in which the problem is limited to the hole in the eardrum, if inflammations are not observed by just protecting the ear from water, if a significant hearing loss in not present and is hearing does not decrease in time, the operation that will be performed to close this hole generally eliminated the need for protecting the ear from water and increases the patient’s quality of life and prevent hearing loss that will occur in time and is performed according to the preference of the patient.

If recurrent ear discharge is observed though the ear is protected from water and there is no focus of infection present in the nose and sinus region, closing of the hole in the eardrum is a medical necessity to increase the quality of life and also to prevent the progression of hearing loss and the formation of complications related to the inflammation. In patients with significant hearing loss, the problems of the bones that transmit the sound should be repaired during the same operation if possible, however, if it is not possible to correct, then the sound transmission system should be repaired by using various surgical techniques, cartilage, bone grafts or middle ear prostheses.

If an inflammation called cholesteatoma, found in the middle ear and mastoid bone, progressing by dissolving bone is detected, this inflammation has to be cleaned as soon as possible with surgery. In patients with cholesteatoma, protection or reparation of the auditory system is the secondary goal; the primary goal is to clean the inflammation before allowing the formation of facial palsy, hearing loss originating from inner ear or intracranial complications (meningitis, brain abscess, etc.). 

Surgery technique;

Generally the surgery technique is decided according to the condition of the disease, location of the hole on the eardrum, structure of the ear canal, whether mastoid bone will be intervened during the surgery, or not, the preferences of the surgeon and finally the preferences of the patient (location of the incision).

During the surgery, though many different surgical techniques are applied under the microscope in the middle ear and mastoid bone, since what the patients and his/her relatives can see is limited to the incision on the skin, question about this issue are asked frequently.

Tympanoplasty surgery may be performed with incisions that are applied inside the ear canal, inside the ear or behind the ear. The surgery may be applied via ear canal just to repair a small hole in the eardrum; for the holes in the middle and posterior part of the eardrum, incision inside the ear and for the holes in the anterior part of the eardrum and in situations requiring intervention to the mastoid bone, incision behind the ear are preferred. The decisive factor on this matter is the preference of the surgeon who will perform the operation.

The tissues that used the most in the reparation of the eardrum are cartilage of auricle and the sheath of the muscle temporalis. Since this tissues are close to the surgical site, it can be easily obtained during the surgery. The membrane of the cartilage found in front of the ear canal and this cartilage itself are also preferred frequently. Ready to use materials (materials like sterile brain membrane pieces that have undergone appropriate processes) are sometimes preferred especially in revision cases due to lack of other tissues.

When reparation directed to the transmission of the sound is required due to the damage in the bones transmitting the sounds, many different materials like prostheses of various materials, pieces obtained from the cartilage located in front of the ear canal, the bones of the middle ear can be used by positioning and shaping these materials.

After the surgery

patients may generally be discharged from the hospital the next day by dressing the wound.

In surgeries in which mastoid bone is not intervened, the special sponges that are placed into the ear are usually removed 10-14 days later and the patients are advised to protect their ears from water and to use ear drops containing antibiotics and cortisone in order to prevent the inflammation and reaction at the site of surgery. Recovery in this group is completed within 3-4 weeks. In general, patients should avoid influenza and impacts and should not travel by air. The technical and pathological success rates in these patients depend on the severity of the pathology and the level of hearing before the surgery and are generally good.

For patients undergoing intervention of the mastoid bone during the surgery, dressings should be applied in varying intervals according to the type of the performed surgery. Recovery takes longer time in this group. The gain in the hearing in these patients his usually lower than the other group.

If the cholesteatoma is located in the surroundings of the facial nerve and inner ear, then in order not to damage the nerve and hearing, bones are not scraped and disease may be left behind at the cellular level. 

For these patients, since the recurrence risk of cholesteatoma is high, they should be followed after the surgery with regular intervals. Interventions to repair the auditory transmission system may be performed in this group of patients with the second control surgery that is performed after 6-12 months when cholesteatoma recurs in the form of small foci.

As a result, there is not a standard approach present to be applied to every patient for tympanoplasty surgeries. In the selection of the surgical technique and the applications that will be used during the surgery, especially in cases with cholesteatoma, mostly the properties of the disease and the patient, factors detected during the surgery and the experience of the surgeon are effective.