Tympanoplasty

In following conditions, such as:

• Complaints of ear pain
• Loss of hearing
• Ringing or beep sound in the ear (tinnitus)
• Not able to walk with the stability (vertigo)
• Feeling of nausea/vomiting due to vertigo

The eardrum is the other name for the tympanic membrane. Chronic infection or trauma can bring damage to the eardrum. This damage requires correction. Tympanoplasty is the corrective procedure for damaged eardrums. The middle ear bones correction is also a part of tympanoplasty. The bones of the middle ear include the incus, the malleus, and the stapes.

The epithelium (first layer and third layer) and collagen fibers (the middle layer) combined together to form the tympanic membrane. Small-sized defects heal by themselves, but large defects size require surgical intervention.

Insertion of any object into the ear canal can harm the eardrum. A blow or an explosion can also cause damage to the eardrum.  

When the patient presents with complaints of pain, any discharge from the ear, loss of hearing, tinnitus, vertigo, or nausea/vomiting due to vertigo, then the doctor may perform a clinical checkup and then advise for diagnostic tests. The diagnostic tests include an audiogram, microscopic examination, and otoscopy. The doctor may also prescribe a fistula test if the patient gives any history of dizziness or perforation of the eardrum

There are five basic types of tympanoplasty procedures:

• Type I tympanoplasty involves repair of eardrum perforation
• Type II tympanoplasty is done in case of perforation along with malleus erosion, which involves grafting onto the incus or the remains of the malleus
• Type III tympanoplasty is done in cases with intact stapes and damage of ossicles. In this procedure, the graft is placed onto the stapes
• Type IV tympanoplasty is done in case of ossicular destruction, including all or part of the arch of the stapes. In this procedure, grafting is done onto or surrounding the stapes footplate.
• Type V tympanoplasty is done in cases where footplate of the stapes is fixed

The type of sedation/anesthesia is procedure dependent.

The preparation for surgery is type-dependent. The patient will get the preoperative instructions and list of investigations.

The surgeon makes an incision into the ear canal to elevate the eardrum away from the bony ear canal. He makes an additional incision in case of large perforation or if the hole is deep inside. Bones are visible after rotating the perforation forwardly. Scar tissue removed using microhooks or a laser. The graft inserted below the eardrum. This graft prepared from the tissue from the ear back or a vein. This gelatin sponge works as a support, to control the displacement of the graft. Ultimately, a sterile patch is placed over the ear canal. 

In general, the procedure time is short, and post the procedure, the patient goes home within 2 to 3 hours. In case of some complication or having an existing disease condition, the patient may be kept in the hospital for observation for a short duration. Antibiotics are helpful in infection prevention.

Nose-blowing and water percolation to the ear should be avoided. Anti-allergic are given in case the patient is already suffering from cold or allergies.

The first follow-up, usually scheduled between 3-4 weeks after the procedure. Evaluation of the condition of the graft is carried out. After 4-6 weeks, the patient needs to undergo a hearing assessment.

The patient can return to normal activities by 6 days and to heavy activities after 4 weeks, that too after the assessment by the doctor.

The complications that may occur include graft failure (not able to heal), narrowing of the ear canal, adhesions in the middle ear, loss of hearing, etc. Some rare complications include cholesteatoma. There are tingling sounds in the ears after the procedure, but usually, it subsides on its own. But sometimes it may worsen.