Tympanoplasty Surgery: Purpose, Procedure, and Benefits and Side Effects

Tympanoplasty is the medical term for ‘tympanic ear drum surgery’ where plasty means ‘to fix’ and tympanic stands for ‘the eardrum’. Hence, tympanoplasty is a surgical procedure done to treat ruptured eardrums. The surgery is needed to repair a rupture in your eardrum or tympanic membrane that separates your middle ear from your ear canal with the help of a natural or synthetic graft. Due to the rupture a hole is formed in your eardrum that prevents it from vibrating thus impairing your hearing.

Often, ear drops or antibiotics are prescribed by the doctor to treat ruptured eardrum. Tympanoplasty surgery, however, may be required if your eardrum doesn't heal after two to three months in order to avoid problems including hearing loss, recurring infections, and vertigo.

Tympanoplasty is an inpatient treatment that typically lasts two hours. Normally, the patient is admitted for an overnight stay in the hospital to make sure there are no postoperative issues.

The goal of all tympanoplasties is to patch your ruptured eardrum. Your healthcare practitioner will use a different way to treat the hole or rupture in your eardrum that may include;

This procedure restores perforated eardrums with the use of grafts made of cigarette paper, fat, Gelfilm, and AlloDerm.

Tympanic perforations with malleus erosion are treated with this method, which involves grafting into the incus or remaining malleus.

This entails destroying two ossicles and inserting a graft onto the stapes while protecting the assembled structure.

This procedure includes wrapping a graft around or onto a stapes footplate and is used to destroy ossicular tissue.

When a stapes footplate is fixed, this procedure is used.

However, to get to your middle ear to repair your eardrum, the surgeon may use any of these listed techniques;

Postauricular tympanoplasty: Your doctor creates a curving incision behind your auricle, or outer ear fold.

Endaural. Over your ear canal, a cut is made.

Transcanal. If your eardrum hole is small and situated in the back of your eardrum, this method is employed. Through your ear canal, your healthcare professional can access your middle ear.

To access the tympanic membrane perforation, two primary methods transcanal and postauricular are used, however the surgeons use underlay or overlay approach to treat the rupture once they reach the tympanic membrane perforation.

This technique includes inserting the graft material beneath the preexisting ear drum. A foam-like material that will disintegrate after a few weeks is used to hold the transplant in place. The eardrum uses the graft as a foundation to construct a new membrane over the perforation.

During overlay technique the current eardrum is removed and the graft is implanted to cover the hole. The graft serves as a foundation for the skin of the ear canal to construct a brand-new ear drum. Similar to the underlay procedure, a foam-like substance that will disintegrate after a few weeks is used to hold the graft in place.

Tympanoplasty restores your damaged eardrum, lowering your risk of permanent hearing loss or persistent infections.

Surgeons often perform tympanoplasty when a hole in the eardrum or tympanic membrane does not close on its own. In addition to enhancing hearing, the procedure stops water from entering the middle ear. Infections that cause the eardrum to burst might lead to children developing a hole in their eardrums. Children's eardrums might rupture as a result of infections.

Here are some of the common causes for tympanic membrane rupture:

• Middle ear infection (otitis media)
• Blunt Trauma (such as slapping the ear with an open hand)
• Penetrating Trauma (deep insertion of foreign objects in the ear, such as inserting a Q-tip too far into the ear canal)
• Barotrauma (due to loud noises or sudden changes in air pressure surrounding the tympanum; such as from scuba diving)
• Head trauma.

Complications or risks from tympanoplasty are very uncommon and may rarely involve;

• Graft failure, in which case your eardrum patch fails to correct the issue
• Damage to your facial nerve or the nerve that controls your sense of taste
• Dizziness
• Cholesteatoma, which is an abnormal skin growth behind your eardrum
• An additional hole developing in your eardrum during surgery
• Hearing ability deteriorates
• Complete hear loss due to the damage to the middle ear's bones

Despite the risks, a tympanoplasty surgery can be a good choice for people with a ruptured eardrum that doesn’t heal on its own or with the help of medicines. The chances of countering the risks can also be ignored or reduced if the surgery is done by an expert ENT surgeon at Pristyn care.

There are some tips and advises that are to be followed before undergoing tympanoplasty;

• For two weeks before surgery, discontinue taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and other non-steroidal anti-inflammatory drugs, vitamin E, herbal supplements, and pharmaceuticals containing these substances
• The night before your surgery, you'll probably be instructed to abstain from eating and drinking after midnight. If you must take medication, drink only a tiny bit of water with it
• Smoking should be avoided for two weeks prior to and two weeks following surgery as nicotine can cause scarring and slow recovery
• You will receive your post operative medicines (usually an antibiotic and painkiller) on the day of the procedure
• If you feel ill, be careful to let the doctor know. Your procedure might need to be delayed in such a situation.

A tympanoplasty is carried out if the eardrum hole is significant or if you have a persistent ear infection that is resistant to antibiotic treatment. For this procedure, you'll probably be hospitalized, and general anesthetic will be used to put you to sleep. The procedure takes 2-3 hours.

During tympanoplasty, the surgeon will first gently remove any extra tissue or scar tissue that has amassed in your middle ear using a laser. The hole in your eardrum will then be patched up by grafting a tiny portion of your own tissue from a vein or muscle sheath. The surgeon will either access your eardrum through your ear canal or by a small incision behind your ear.

The whole procedure can be understood through the following following three important stages;

• On the morning of surgery, refrain from eating or drinking anything, not even water.
• Take your necessary pills with just a sip of water
• Dress comfortably in clothings that fastens in the front or back. Avoid wearing garments with slipovers
• Do not wear jewelry and leave all valuables at home
• Don't use any eye or facial makeup. Don't use nail polish
• You are permitted to wear glasses, but not contact lenses
• Keep your dentures in if you wear them.

The surgeon must consider the location and size of the perforation when tympanoplasty is considered.

• In Type I Tympanoplasty when perforation is small, an incision is made into an ear canal to elevate away and lift the remaining eardrum forward from the bony ear canal, using an operating microscope to see into the ear. If perforation is large or if it is far forward, away from the surgeon’s view, an incision might be performed behind the ear to elevate the outer ear forward, which helps in providing access to perforation.
• When the perforation is exposed, the remnant is forwardly rotated and the bones are inspected. Scar tissue, if present, is removed with laser or micro hooks.
• Tissues are taken from the back of the ear, the tragus, or from a vein, then dried and thinned.
• The graft is supported by placing an absorbable gelatin sponge under the eardrum, then inserted underneath the eardrum remnant, and folded back onto the perforation to provide closure. The sheet is also then placed against the graft which helps to prevent it from sliding out.
• If it is open from the back, the ears are stitched together with sutures being buried under the skin. A sterile patch is placed outside the ear canal.

However, when doing tympanoplasty, there are two approaches to reach the tympanic membrane rupture; the transcanal (through the ear canal) or postauricular (behind the outer ear) approaches. Both the approaches are differently done and are as follows;

Except for a little incision behind the ear necessary to access the graft material, the transcanal that means ‘through the ear canal’ is literally done entirely through the ear canal. The transcanal technique is only used for eardrum ruptures that are relatively minor and are present in the posterior (rear) region of the tympanic membrane. The transcanal technique only provides a partial or restricted view of the front (anterior) section of the eardrum as a result.

Surgeons most frequently use the postauricular (behind the outer ear) method when doing tympanoplasty. This method involves making a curving incision directly behind the outer ear's crease also known as the auricle. In contrast to the transcanal method, the postauricular approach provides a clear view of the whole eardrum.

• You will be taken to a different room where you will stay till your anesthesia wears off
• Your ear will be packed with cotton after surgery. This packing needs to stay in your ear for five to seven days following your surgery
• Your entire ear is typically wrapped in a bandage to keep it safe
• Usually, patients who have an eardrum repair treatment often get discharged from the hospital right away
• After the procedure, you can be given ear drops. Put the drops in your ear after gently removing the packaging
• Do not insert anything else into your ear, just replace the packing.

Tympanoplasty cost in India can range from Rs. 35,000 to Rs. 60,000, depending on a number of variables, including the location of the hospital and city of treatment, the severity of the condition, the type of graft used, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved etc. may have an influence on hospital billing expenses.

You can eat soft, ordinary meals after 24 hours of the tympanoplasty. After surgery, stay away from hot or spicy foods for at least a week.

Here are some of the food items that are well suited for people who undergo tympanoplasty;

• Apple sauce
• Banana
• Berries
• Smoothies
• Yogurt.

Tympanoplasty is a simple and safe outpatient operation that can both treat middle ear illness and improve hearing and middle ear function.

The first few days following surgery may be accompanied by some moderate pain, however this could be managed with the help of some over-the-counter (OTC) pain relievers.

Recovery could take eight to twelve weeks after tympanoplasty. It's crucial to keep your ear dry while you're recovering. Additionally, you must refrain from exerting too much pressure on your eardrum through hard lifting, strenuous exercise, and other activities.

Surgery to fix a perforated eardrum typically doesn't result in any major complications. However, there are potential risks, such as;

• A wound infection
• Graft failure
• Disruption in sense of taste
• The eardrum may get worse and the tear may become bigger
• A permanent hearing loss.

• To reduce swelling, keep your head elevated. The use of a recliner or adding an additional pillow to your bed will be helpful
• It is common to have a discharge from an external ear for a few days after surgery. But if this problem continues, the doctor should be consulted
• You might anticipate wearing a large headdress. Keep the dressing dry even if you wash your face. You will be given instructions at the time of discharge to return to the clinic the following day for the removal and changing of the dressing. Up until your follow-up appointment about five days after surgery, the dressing must be left in place
• Apply bacitracin ointment three times daily for two to three days to the incision once the dressing is taken off
• Keep the ears dry until it heals completely
• After the dressing is taken off, you can gently shampoo your hair while being careful not to bend the ears
• When brushing or styling your hair, take careful not to bend your ears or hit them
• Wearing your glasses is acceptable, but you should tape them up so they don't sit on the incision
• There may be some numbness or areas of diminished sensation. Over time, the sensation will return to normal. Use caution when using blow dryers, curling irons, etc. to prevent burns
• For one week, wear the headband over your ears day and night; the next week, only at night
• Avoid engaging in vigorous physical activity, such as sports and sexual activity. Three days following surgery, you can start light walking again. Three weeks after surgery, progressive resumption of aerobic exercise, weight training, hard lifting, and straining is permitted
• During the first week after surgery, kids can go back to school, but they must wear the headband constantly and refrain from playing sports or taking physical education classes
• Swimming is not permitted for 4-6 weeks following surgery
• For six weeks following surgery, avoid all sun, sunlamps, and tanning beds at all cost
• If there is swelling in the ears, don't be alarmed; it generally goes away in two weeks. It could take a little longer for all edema to go down in certain cases
• Avoid flying for a few weeks post-surgery to protect tympanums against fluctuating air pressure
• Avoid coughing, straining, blowing nose, and sneezing to avoid dislodging of graft
• Take only the medications that your doctor has prescribed.

Tympanoplasty is one of the best ways to treat a ruptured eardrum and middle ear when other non-surgical methods fail to work. This procedure not only restores hearing loss or problem but also helps in removing infections and alleviating discomfort. However, it is always advisable to see a specialist before considering any surgical procedure.