Tympanoplasty is an operation on the ear. It is necessary following injury or inflammation of the eardrum or ossicular chain. The aim of tympanoplasty is to close the eardrum defect and reconstruct the ossicular chain. Tympanoplasty can be performed under local or general anesthesia.
Here you will find further information as well as selected tympanoplasty specialists and centers.
An unhealed eardrum defect and damaged auditory ossicles mean impaired sound transmission. In addition, middle ear infections can occur repeatedly.
The auditory ossicles consist of
These are the smallest bones in the human body. Together they form the so-called ossicular chain.
Regular inflammation can permanently damage or even completely destroy the ossicles. In addition, the so-called cholesteatoma, a special case of chronic middle ear inflammation, can lead to considerable complications.
In order to remedy the resulting problems, the eardrum defect needs to be surgically closed. In the course of this, the ossicular chain is reconstructed. This procedure is known as tympanoplasty.
Doctors differentiate between various forms of tympanoplasty. They range from simple eardrum closure to complete replacement of the ossicles. Today, type I and type III tympanoplasty are among the most common surgical techniques.
The anatomy of the human auditory organs with the hammer, anvil and stirrup ossicles © Henrie | AdobeStock
When making a diagnosis, the ENT specialist will ask the patient about
This allows him to obtain information about the causes of the disease and assess the severity of the symptoms. This is followed by a preliminary hearing test using a tuning fork.
The affected ear is usually examined using a microscope. This allows the doctor to assess the size and location of the defect and rule out any current inflammation. Next, a hearing test is carried out to assess the hearing loss.
A computer tomography(CT) scan can be carried out to determine the extent of the disease, for example if
Tympanoplasty can be performed under local or general anesthesia. The doctor should take the patient's wishes and pain sensitivity into account when making the decision. In the case of local anesthesia, the patient must be able to lie still for a longer period of time during the tympanoplasty.
The skin incision for the access route can be
be made. The decision essentially depends on the patient's anatomy and the location of the eardrum defect.
After the skin incision, the ear canal skin is lifted away from the bone in the direction of the eardrum until the edge of the eardrum becomes visible. The surgeon then detaches this edge from the bone and folds the eardrum upwards.
The edges of the eardrum defect are cut around so as not to remove any vital tissue and to improve the healing tendency.
The surgeon can choose from various autologous tissues to close the defect. The following are available
The surgeon harvests the tissue without further incisions in the exposed surgical area. In the case of very small defects and sufficiently perfused eardrums, fatty tissue can also be used.
The surgeon can either reconstruct the existing ossicles or insert prostheses (usually made of titanium). To close the eardrum, the transplant is placed behind the eardrum (underlay technique). It usually adheres independently to the back of the eardrum due to adhesive forces.
At the end of the operation, silicone sheets are inserted into the ear canal and attached to the skin of the ear canal. The ear canal is then stuffed with a tamponade (cellulose or gel). The tamponade presses the ear canal skin against the bony ear canal and thus supports healing.
The operation is completed with the skin suture and wound dressing.
In addition to regular wound checks, a hearing test should be carried out after the operation to check hearing performance.
After 8 to 10 days, the skin sutures are removed.
The ear canal tamponade and the silicone foils can be removed depending on the
removed between the 5th and 21st day after the operation.
The complications and risks of tympanoplasty include
In addition, hearing gain may be limited. Facial nerve paralysis is a very rare complication.
Tympanoplasty is a safe method of closing an eardrum defect and reconstructing the ossicular chain. The risks of complications are very manageable with an experienced surgeon. Complications only occur in very rare cases.
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