Tympanoplasty: the tympanic mebrane surgery

What is a tympanoplasty?

Tympanoplasty is the surgery done for the treatment of chronic cholesteatomatous and non-cholesteatomatous otitis. Tympanoplasty involves repairing of the tympanic membrane and the ossicular chain.

Why is a tympanoplasty performed?

Tympanoplasty aims to restore the integrity of the tympanic membrane (eardrum) and the ossicular chain after cases of chronic otitis media. Surgery is indicated when the infection has caused perforation of the eardrum membrane and has damaged the mucosa and ossicles.

What to do before the tympanoplasty

The patient undergoes an anamnesis accompanied by an otolaryngological examination and an examination with otoscopy befor the surgery. Tests such as audiometric impedance are done and radiographic exams like CT and magnetic resonance can also be performed. It is advisable to rest and avoid eating and drinking a few hours before the surgery.

Tympanoplasty surgery: the procedures

The surgeons will make a curvilinear incision of about 3 cm behind the auricle and after removing a small part of the bone they will have access to the tympanic membrane. At this point the surgeon will proceed with the reconstruction of the eardrum through the application of tissue taken from another body part. The operation is performed under general anesthesia, with hospitalization lasting one night.

One-stage tympanoplasty

Just one operation of tympanoplasty eliminates the infection, the perforation of the tympanic membrane is repaired and the ossicular chain is rebuilt with the aim of improving hearing.

Staged tympanoplasty

Staged tympanoplasty is mainly used in cases of cholesteatoma. This technique consists of a first intervention that can eradicate the disease and after that, the procedure to reconstruct the eardrum is performed. The doctor then applies a small silicone coating to the mucosa to aid in healing and recovery. About 8-12 months after the first operation and after complete healing, the patient undergoes the second functional intervention for the reconstruction of the ossicular chain and the restoration of auditory function.

Closed tecnique tympanoplasty

With the closed technique, an attempt is made to restore the ear's original anatomical position, preserving the bone wall of the auditory canal or reconstructing it if it is damaged. After microsurgical cleaning, mastoidectomy allows to obtain a large and regular cavity of all the bone cells of the mastoid that it will thus be free from the pathological tissue. This process does not cause any disturbance to the patient and will be able to prevent the mastoid cavity from becoming illagain in a chronic form.

Open technique tympanoplasty

In some cases, tympanoplasty associated with mastoidectomy performed with an open technique suggested. In this case, the operation requires that the ear canal wall is removed and the mastoid cavity is placed in through the opening of the acoustic meatus, effectively enlarged with a specific remodeling technique (concomeatoplasty)

Types of tympanoplasty

There are two main types of tympanoplasty: the open technique and the closed technique. The choice of a tympanoplasty made with an open or closed technique is discussed by the doctor with the patient only after a precise evaluation of important medical indicators, such as the age, the general health conditions of the patient, the hearing capacity of the other ear or the possible presence of previous otological interventions.

Are there any risks from tympanoplasty?

The risks and possible complications of a tympanoplasty are:

wound infection,
chondritis i.e. inflammation of the auricle,
tinnitus,
dizziness,
lesion of nerves important for the motor function of the face and for the sense of taste,
lesion of vascular structures with consequent haemorrhage,
post-operative intracranial infections,
general complications of major surgery (respiratory and cardiac).

Recovery after tympanoplasty surgery

The patient needs 2 weeks of psychophysical rest after a tympanoplasty, in which they must avoid:

intense physical work;
diving in water;
high mountain trips;
travel by plane;
sudden and rapid movements of the head;
contact sports; strenuous exercise;
intense and prolonged efforts;
loud and prolonged noises;
blowing one's nose with great effort;
avoid excessive pressure changes.

In the post-operative phase, the wounds must remain dry until complete healing; the sutures are generally removed about a week after the operation and the dressings are also removed after 3 weeks.

Tympanoplasty and hearing aids

In cases where satisfactory hearing recovery is no achieved, hearing aids can be used.

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Tympanoplasty