TYMPANOPLASTY (EARDRUM RECONSTRUCTION SURGERY)

TYMPANOPLASTY (EARDRUM RECONSTRUCTION SURGERY)

The surgery may be in various forms depending on the size and location of the disease, such as repairing only a perforation in the eardrum (Myringoplasty), repairing the small bones of the middle ear transmitting sounds together with eardrum reconstruction (Tympanoplasty), removing the inflammation from inside the mastoid bone (Mastoidectomy), or a combination of these procedures (Tympanomastoidectomy).

Is it absolutely necessary to undergo an ear surgery?

If inflammation is prevented by simply protecting the ear from water in cases where the only problem is a perforated eardrum, surgery should be optional and up to the patient's decision.   Hearing loss is nearly zero in simple eardrum ruptures, meaning surgery is not absolutely necessary for these patients.  On the other hand, patients with cholesteatoma, the inflammation destroying the bones of the middle and inner ears, are at risk of possibly life-threatening problems, and surgery is absolutely necessary.

When to have tympanoplasty?

While the recommended ideal time for simple eardrum reconstruction surgery is after the age 12 -14, it is absolutely necessary for patients with potential severe inflammation to undergo surgery (sometimes under emergency conditions) regardless of their age.

What conditions is tympanoplasty performed for and what are the health benefits?

If there is still recurring ear drainage despite protecting the ear from water and/or absence of a focus of infection in the nose or the sinuses, the perforation in the eardrum can be repaired to both improve the quality of life and prevent the progress of the hearing loss and the development of inflammation-induced complications. In patients with prominent hearing loss, the problems in the small bones transmitting the sounds can be corrected during the same surgery. There are various surgical techniques for this purpose. Cartilage and bone grafts or middle ear prostheses can be used with these techniques.

If cholesteatoma, an inflammatory tissue progressing by eroding the bones, is detected in the middle ear and the mastoid bone, the inflammation should be surgically removed as soon as possible.   In patients with cholesteatoma, protection or repair of the hearing system has the secondary priority since the main goal is to remove the inflammation before facial palsy, hearing loss originating from the inner ear, or intracranial complications (meningitis, brain abscess, etc.) occur.

What is the surgical technique?

There are multiple factors to consider in determining the surgical technique, such as the prognosis, location of the hole in the eardrum, structure of the ear canal, whether there will be an intervention to the mastoid bone during surgery, surgeon's choices, and finally the patient's choices.

Although a great variety of techniques are used in the middle ear and the mastoid bone under the microscope during surgery, patients and their relatives often ask questions about the incision on the skin since that is the only thing they can see related to surgery.

Tympanoplasty can be performed through the ear canal, or with anteroauricular or post-auricular incision. While the surgery can be performed through the ear canal or an incision on the front side of the auricle when the aim is to repair only a small hole in the eardrum, post-auricular incisions are preferred where the mastoid bone should be surgically intervened. The determining factor here is the choice of the surgeon who is to perform the surgery.

The most commonly used tissue to reconstruct the eardrum is the temporalis muscle fascia. Since this tissue is close to the surgical site, it can be easily accessed during surgery.  While the membrane of the cartilage in the anterior wall of the ear canal or ready-made materials (such as properly treated and sterilised parts of ear or cartilage membrane) can be used, the safest and most economical method is to use the patient's own tissues.

What is the postoperative care like?

Patients are usually discharged one day after the surgery once their wound has been dressed. 

For the surgeries where the mastoid bone has not been intervened, the wicks inside the ears are removed usually after 10 to 14 days, and the patients are advised to protect their ears from the water and use ear drops containing antibiotic agents and cortisone to prevent the infections and adverse reactions in the surgical site. This groups recovers completely in 3 to 4 weeks. Depending on the severity of the disease and preoperative level of hearing, technical and functional success of the surgery in this patient group is usually high.

For patients undergoing surgery intervening the mastoid bone, however, wounds should be dressed several times for a while depending on the type of surgery. Recovery takes a longer time in this group. Hearing gain in this patient group is usually lower than the other group.

In the cases where especially the cholesteatoma is located adjacent to the facial nerve and the inner ear, the bone cannot be scraped in these areas due to the risk of damaging the nerve or hearing, and thus the disease may still remain at the cellular level.

Since there is a high risk of recurrence of cholesteatoma for such patients, regular follow-up checks should be done after the surgery. The second-look procedure may be performed 6 to 12 months after the first stage to determine the presence of cholesteatoma as early as possible.

What to do after the surgery?

Generally, patients should protect themselves from influenza, especially during the first month. Furthermore, patients should protect themselves from blows to the ear, meaning they should avoid, for the duration advised by the physician, the sports involving one-one-one competition where players may receive a blow. Patients should avoid getting water into the ear by sticking a Vaseline-dipped piece of cotton wool into the ear canal until the physician instructs to stop doing so. Patients should avoid pressure changes, which means they should not take a road trip which may involve altitude changes, and flights in particular, for 4 to 6 months.