Tympanoplasty

Who Needs Tympanoplasty?

Tympanoplasty is a surgical procedure done to repair a perforated eardrum (tympanic membrane) or to reconstruct the tiny bones found within the ear. It is generally advised for people who have perforations in the eardrum, long-term infection, or inflammation in the middle ear (chronic otitis media), hearing loss, abnormal growth of skin cells in the middle ear (cholesteatoma), or recurrent ear infections. The procedure can restore hearing, stop recurring ear infections, and also promote the general health of the ear. Ultimately, the decision to undergo tympanoplasty is based on individual circumstances, including the severity of symptoms, the underlying cause of the ear condition, and the potential benefits and risks of surgery.

What Conditions are Treated with Tympanoplasty?

Conditions  that are treated with tympanoplasty include:

• Perforated eardrum: Tympanoplasty is used to repair holes or tears in the tympanic membrane caused by trauma, infection, or other problems.
• Chronic otitis media: If you’ve had repeated ear infections that haven’t cleared up with medical treatment, you may need tympanoplasty.
• Conductive hearing loss: If you have hearing loss caused by damage to the small bones in your middle ear, such as your eardrum or the bones behind your eardrum (ossicles), your doctor may suggest tympanoplasty.
• Cholesteatoma: This is the abnormal growth of skin cells in your middle ear behind the eardrum. It can damage the bones of your middle ear. Tympanoplasty can be used to treat the condition and prevent repeated ear infections.
• Barotrauma: If you’ve had a sudden change in pressure, such as while scuba diving or flying, and you’ve damaged your eardrum, you may need tympanoplasty.

What Causes Ruptured Ear Drums?

Perforated eardrums, also known as ruptured eardrums, can occur due to several reasons. These reasons include:

• Trauma: When an accident occurs, blows, injuries, and falls experienced directly on the ear may cause the eardrum to perforate.
• Barotrauma: Extremely fast changes in the air pressure for instance during an explosion enclosure, air travel, and scuba diving can put excessive pressure on the eardrum which creates perforation.
• Infections: Severe or chronic ear infections, particularly otitis media (inflammation of the middle ear), can lead to the accumulation of fluid or pus behind the eardrum. The pressure from this buildup can eventually cause the eardrum to rupture.
• Foreign objects: Inserting objects such as hairpins or pencil-like objects too far into the ear can cause the eardrum to over-stretch and eventually rupture.
• Loud noises: Unusually loud noises may cause pressure in the ear to increase suddenly which as a result causes the eardrum to perforate.

Different Types of Tympanoplasty Surgeries?

The different types of tympanoplasty surgeries can depend on what the patient needs and the extent of the damage to the tympanic membrane and middle ear structures. Here are a few different types of tympanoplasties:

• Type I Tympanoplasty (Myringoplasty): Reconstruction of a small hole in the eardrum, without repair of the middle ear bones.
• Type II Tympanoplasty: Reconstruction of the eardrum and middle ear bones (the hearing bones), called ossicles. This procedure is often used for patients with moderate-sized holes or patients with holes and poor middle ear bone function. 
• Type III Tympanoplasty: Reconstruction of the eardrum, ossicles, and middle ear space, and is often used for patients with larger eardrum holes and significant middle ear bone disease.
• Type IV Tympanoplasty (Tympanomastoidectomy): It is indicated for patients with extensive disease involving the middle ear, mastoid bone, and mastoid air cells. It involves the removal of the diseased tissue (including cholesteatoma) and reconstruction of the eardrum and middle ear structures.

The specific type of tympanoplasty recommended for a patient depends on factors such as the size and location of the eardrum perforation, the extent of middle ear disease, the condition of the ossicles, and the patient's overall health. 

Who Qualifies for Tympanoplasty?

Qualification for tympanoplasty is assessed by an ENT specialist. Several factors determine the eligibility of a patient. However, a general list of individuals who are likely to be candidates for a tympanoplasty.

• Those with a perforated eardrum, with the symptoms of hearing loss, recurrent ear infections, or drainage from the ear.
• Patients who tried conservative therapy and failed. This may include, antibiotics, and ear drops, for chronic otitis media and recurrent ear infections.
• Individuals with conductive hearing loss that is caused by damage to the middle ear structures including the tympanic membrane and the ossicular chain.
• Folks with cholesteatoma, which is an abnormal growth in the middle ear, that can lead to complications.
• Individuals with traumatic eardrum perforation that has occurred in accidents falls, and barotrauma.
• Patients with eardrum perforation that has occurred during previous surgery or a medical procedure
• Patients who have had a diagnostic evaluation, which may have included, a hearing test, and an otoscopy, confirming the need for a tympanoplasty.

When to Contact a Doctor?

It's crucial to consult a doctor, specifically an ENT specialist or otolaryngologist if you are experiencing any of the following symptoms related to your ears:

• Ear pain: Persistent or severe ear pain can indicate various conditions such as an infection or perforation.
• Loss of hearing:  Sudden or gradual hearing loss, especially if it occurs in one ear, along with other symptoms.
• Drainage from the ear: Any fluid, pus, blood, or any unusual discharge from your ear.
• Tinnitus: A ringing sensation in your ears or tinnitus that’s sudden or that you notice more often.
• Dizziness or vertigo: Dizziness or vertigo that is severe and accompanied by nausea or vomiting.
• Ear pressure or fullness: A persistant feeling of fullness, pressure or blockage in the ears. 
• Changes in ear appearance: Physical changes in the ear that may include redness, swelling, or an apparent injury to the outer or inner ear.
• History of ear trauma or injury: If you have experienced significant trauma or a blow to the face or ears.
• Recurrent ear infections: If there are recurrent ear infections or if they persist even after treatment, or frequent episodes of ear infections.
• Problems with balance or coordination: If you experience lack of balance or lack of coordination it could indicate a problem of the inner ear.

If you are experiencing any of these above-mentioned symptoms, it’s important to consult a medical professional right away. They will be able to determine what is causing your symptoms and guide you towards a proper treatment. Waiting to get help for your symptoms, or putting it off could lead to more harm than good.

Tympanoplasty Surgery Procedure

Tympanoplasty is a surgical procedure performed to repair a perforated eardrum or to reconstruct the middle ear bones. Here is a typical summary of the steps involved in a tympanoplasty.

• Anesthesia: General anesthesia is typically used so the patient can sleep throughout the surgery and not feel any pain. Local anesthesia combined with oral or IV sedation may be an option in some cases.
• Preparation: The surgeon will clean the surgical site and position the patient depending on the type of procedure being performed. In most of the cases, patients will lie on their back with the affected ear facing upward.
• Incision: An incision is made either behind the ear (postauricular approach) or inside the ear canal (endaural approach) depending on the type of the procedure and the location of the perforation.
• Exposure: The surgeon carefully cleans off the tympanic membrane (eardrum) and may also lift the skin of the ear canal or drill through the bone to access the middle ear.
• Graft Placement: In some cases, graft material is needed. The surgeon may use a tissue graft taken from the patient's own body such as the tragus or temporalis fascia or a grafting from a synthetic membrane. The graft material is placed precisely over the perforation to rebuild the tympanic membrane.
• Ossicular reconstruction (if necessary): Ossicular reconstruction is done if the ear bones, stapes, incus, or malleus have been damaged. These structures, in the middle ear, will be repaired to restore as much of normal hearing as possible if they have been damaged.
• Closure: When the graft is securely in place, the surgeon carefully closes the incision with sutures. Some patients may have a small packing placed in the ear for additional support, while others may have a dressing applied to the outside of the ear.

Patients may go home the same day or be kept overnight depending on the complexity of the procedure and their health.

What Happens After Tympanoplasty Surgery?

After the procedure, the patient is taken to the postoperative recovery area for a short period of observation. The tympanoplasty procedure typically lasts from 1 to 2 hours depending on the extent of the disease and the type of graft material used. The patient is discharged the same day in most cases.

• Pain management: After the surgery, it is normal to experience some amount of pain and doscomfort. This is temporary and can be managed with prescribed pain medications. 
• Taking care of Ears: Patients need to take care of their ears as instructed by the surgeon. Follow instructions given by the surgeon which may include preventing the ear from getting wet, and not inserting any foreign objects in the ear. 
• Restrictions on Activity: You may be asked to avoid strenous activities, that can put an extra load on the ear such as running, swimming, diving, and many more.
• Follow-up appointments: Patients are supposed to adhere to the follow-up appointments that are scheduled or given by their surgeon in order to track their progress.
• Monitor for complications: Rare immediate complications like bleeding, infection, or worsening of symptoms should be reported immediately. Also, if there is a sudden change in hearing or if pain or pressure becomes excessive, then make sure to contact your surgeon immediately.

In conclusion, aftercare is an extremely important part of the tympanoplasty. It needs communication, care, and patience. 

Recovery and Outlook

Recovering from ear surgery and the outlook after surgery will always be different depending on the patient, the type of procedure and patient's overall health. What you can expect during the recovery time may include:

• Initial discomfort: Usually there is some discomfort immediately after surgery, but it can usually be well controlled with medications prescribed by your surgeon.
• Restricted activities: Generally speaking, heavy or contact sports should be avoided for 6 weeks to avoid the risk of trauma to the ear. Adult patients are typically advised to avoid any activity that increases their blood pressure for the first one to two weeks after surgery.
• Ear care: This could be swimming, using headphones or ear plugs, or even activities around the house that result in increased sweating. The ear must be kept dry and clean following surgery. An ear band may be used as protection from minor contact.
• Follow-up appointments: You will have several follow-up visits with your surgeon over the next 6 months to assess your recovery and hearing results. As your ear continues to heal, it will take on a more natural shape, and any post-surgical swelling will decrease.
• Gradual improvement in hearing: Your hearing will not be markedly improved immediately following the surgery. You will notice a gradual improvement in your ability to hear throughout the first several weeks to months. We expect the final hearing results to be the best that we can achieve in the long term.