Tympanoplasty Surgery
The gateway to healthy hearing: Tympanoplasty
What is Tympanoplasty?
The surgery known as “tympanoplasty” is a procedure performed in cases of chronic middle ear diseases. Technically, it involves cleaning infection in the middle ear and mastoid bone, as well as repairing the eardrum and the hearing mechanism within the middle ear. The procedure may vary depending on the extent of damage.
In some cases, only the perforation in the eardrum is repaired (myringoplasty). In other cases, the surgery also includes reconstruction of the ossicular chain that transmits sound in the middle ear (tympanoplasty). If infection has spread into the mastoid bone, a mastoidectomy may be performed. In more complex cases, all these procedures can be combined (tympanomastoidectomy).
Why is Ear Surgery Necessary?
The need for surgery depends on the patient’s condition. If the problem is limited only to the eardrum and there is no active infection, and the ear can be protected from water exposure, surgery may be performed based on the patient’s preference.
In simple eardrum perforations, hearing loss is approximately 30%, and these cases do not always require mandatory surgery. However, in cases where cholesteatoma develops and causes destruction of the middle and inner ear bones, surgery becomes essential, as life-threatening complications may occur.
When Should Tympanoplasty Be Performed?
In simple eardrum repair cases, the ideal age is generally after 12–14 years. However, in cases of advanced infection, patients can be operated on at almost any age. The decision is based on the urgency of the condition.
In Which Situations Should Tympanoplasty Be Performed?
If there is a perforation in the eardrum and recurrent ear discharge occurs despite water precautions, or if infections persist even when nasal and sinus conditions are under control, closing the eardrum defect may be necessary to improve quality of life.
If the patient has significant hearing loss, problems in the ossicular chain responsible for sound transmission can also be corrected during the same surgery. Various surgical techniques may be used for this purpose, including bone grafts, cartilage, or middle ear prostheses.
If cholesteatoma (an aggressive infectious tissue) is detected in the middle ear or mastoid bone, it must be removed as soon as possible. In such cases, restoring hearing becomes secondary. The primary goal is to prevent serious complications such as brain infections, facial paralysis, or permanent inner ear-related hearing loss.
Will a hole in the eardrum heal on its own?
How is the Surgery Performed?
Before deciding on the surgical technique, the patient's condition, the structure of the ear canal, the location of the hole in the eardrum, whether or not the mastoid bone will be involved in the surgery, the surgeon's assessment of the situation, and the patient's preferences should all be considered.
Very different surgical techniques can be applied to the mastoid bone and the middle ear during surgery. However, since the patient or their relatives only see the incision on the skin, they often ask questions about the details.
The surgery is performed through incisions made inside the ear canal, behind the ear, or in front of the auricle. If only a small hole in the eardrum needs to be closed, the surgery can be performed inside the ear canal or in front of the auricle. However, if intervention in the mastoid bone is required, an incision behind the ear is frequently preferred. The expert surgeon's preferences are important in this regard.
The most commonly used tissue in eardrum repair is the temporalis muscle sheath. Because this tissue is close to the area to be treated, its transfer is also much easier. The procedure can use cartilage membrane or ready-made materials, but the most reasonable and cost-effective option is to use the patient's own tissue.
What is the Post-Operative Process Like?
Patients can generally be discharged on the first day after surgery, including dressing changes. In surgeries where the mastoid bone is not involved, special sponges inside the ear are cleaned after 10-14 days. Patients are then advised to use ear drops containing antibiotics and cortisone. This is necessary to prevent infections in the surgical area. Healing usually occurs within 3-4 weeks in these cases.
The success rate of surgeries varies depending on the extent of the disease, but is generally quite good. If the mastoid bone has been manipulated during surgery, various dressing changes may be necessary. In these cases, healing may take some time. Hearing gain may also be slightly less in this group compared to others.
If the cholesteatoma is located near the facial nerve and inner ear, bone scraping is not performed in these areas to avoid damaging hearing and nerve structure. Therefore, there is a possibility of residual disease at the cellular level.
Patients facing such situations have a high probability of cholesteatoma recurrence. Therefore, regular check-ups are necessary after surgery. In patients with this condition, a second surgery may be necessary after 6-12 months, following follow-up examinations, due to the early detection of cholesteatoma.
Post-Operative Care Instructions
It is essential to protect yourself from viral infections, especially in the first few months after surgery. Additionally, the ear should be avoided. Therefore, sports involving physical contact, such as basketball, should be avoided. Until the specialist doctor deems it sufficient, the ear canals should be plugged with petroleum jelly-coated cotton swabs to prevent water from entering. It is also important to avoid the effects of high and low pressure. If a change in altitude is anticipated on the road, it should be avoided, and air travel should also be avoided for a while.
