Tympanoplasty is a surgical procedure that is performed to repair or reconstruct badly torn or perforated eardrum. Tympanoplasty may be needed to be carried out in several cases especially if there is congenital deafness or injury to the tympanic membrane of the middle ear. This may be due to accidents, trauma to the eardrum and chronic or serious middle ear infections.
Eardrum perforations are characterized by symptoms like bleeding, discharge, and loss of hearing and an appointment with the doctor should be made as soon as symptoms persist. An otoscope is an instrument used to examine the ear for ear perforation diagnosis. A hearing test is also carried out to know if there are a hearing loss and the severity of the condition. Not all hearing perforations require surgeries. Some are minor cases and heal on their own with time. However, a tympanoplasty is required if the injury does not heal after a few weeks or is recurring.
Tympanoplasty can be carried out in three ways; a cut through the ear canal is known as a transcanal approach, an incision made in the ear which is the endaural approach and lastly an incision made behind or at the back of the ear known as the postauricular approach. A graft is usually been used to repair or reconstruct the tympanic membrane. The tragus (small cartilaginous lobe of skin in front of the ear) and temporal fascia are the commonly used graft sites. The time required to perform the surgery depends on the way it is carried out. It takes about 30 minutes to one hour if it is performed using the transcanal approach and about 1 hour to 2 hours if it is through the postauricular or endaural approach. It is generally done under local or general anesthesia. A tympanoplasty procedure is usually performed outpatient, meaning patients are able to return home later the same day.
A perforated eardrum usually affects the small interconnected bones of the inner ear known as the ossicles (the hammer, anvil, and stirrup). This is particularly common among children due to ear infections. In this case, surgery usually involves the replacement and repair of the bones involved. This is called Type II (if the malleus is eroded), Type III (if the malleus and incus are eroded) and Type IV (if all the ossicular parts are destroyed). Myringoplasty is also known as Type 1 tympanoplasty and is done if there is only a small perforation in the eardrum and is repaired by grafting.
Every surgical operation has risks including tympanoplasty despite it being considered as a safe procedure.
Risks of tympanoplasty may include excessive bleeding, infection, breathing problems, adverse reaction to anesthesia, loss of hearing and facial nerve injury. These complications are considerably low and are minimized by allowing only an experienced or skilled surgeon to perform the procedure. The symptoms experienced before the surgical procedure, such as loss of hearing, usually cease almost immediately after the tympanoplasty procedure. During the period immediately following a tympanoplasty, patients should refrain from some physical activities such as swimming, air traveling, heavy nose blowing, sneezing with the mouth shut, drinking with a straw and should avoid crowded areas. After a period of four to six weeks, another hearing test is carried out on the patient.