When is tympanoplasty recommended?
It may be required if:
- 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
What is tympanoplasty?
The eardrum is also called a ‘tympanic membrane’. The eardrum may get perforated because of chronic infection or due to trauma and this needs to be repaired. The procedure to correct the eardrum damage is called tympanoplasty. With this procedure, even the small bones of the middle ear viz. incus, malleus, and stapes are repaired
Anatomy of the tympanic membrane
The tympanic membrane is made of three layers. The first and third layer is made of epithelium cells and the second layer is made up of collagen fibers. Clinically it has been established that small perforations do not require intervention and heal by self. And if the defect size is relatively large, with deficient blood supply and an ongoing infection, the process of healing is disturbed. There may be perforation to eardrums because of injuries, such as the insertion of an object inside the ear, or a blow or due to an explosion.
How is the defect diagnosed?
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
Types of tympanoplasties
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 use of local or general anesthesia depends on the type of tympanoplasty being done.
Before the Procedure
The preparation for surgery is type-dependent. The doctor will explain what needs to be done and what all investigations to be done before undertaking the intervention.
An incision into the ear canal is made and eardrum elevation is done away from the bony ear canal and is lifted. An additional incision is made behind the ear if the perforation is very large or hole is deep inside. After the exposure of perforation, the perforated remains are forwardly rotated and bones are inspected. The scar tissue is removed with micro hooks or with a laser. Tissue from the ear back or a vein is taken. These are then made into thinner slices and then dried. The graft is inserted underneath the eardrum remnant using an absorbable gelatin sponge. Support is given by a gelatin sponge and closing of the perforation is done. Protection is given so that graft does not displace when the patient sneezes.
If a deep incision is made, then stitching is done, which is under the skin and not visible. Finally, a sterile patch is put over the ear canal and then the patient is moved out of operation theatre.
After the Procedure
The procedure is generally short and after the procedure, the patient is allowed to go home after 2 to 3 hours. In case of any other comorbidity, the patient is kept under observation for a day or two. To prevent operative complications, antibiotics are prescribed and painkillers for pain relief.
Instructions regarding avoidance of nose blowing and keeping the ear safe from water are given. If the patient is suffering from any cold or allergies, treatment is prescribed for the same.
The patient is instructed on follow-ups. After 3-4 weeks, the graft is checked under an operating microscope for healing. And a complete hearing test is done after 4-6 weeks after the operation.
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.
Ringing in the ear (tinnitus) may be heard initially but with the healing of graft and closure of the eardrum, it will disappear and in some cases, it may worsen.