Tympanoplasty (also called eardrum repair) is a surgical procedure that repairs or reconstructs the perforated eardrum to help restore normal hearing. This procedure may also involve repair or reconstruction of the small bones (ossiculoplasty) behind the tympanic membrane, if needed. Both the eardrum and middle ear bones (ossicles) have to function well together for normal hearing process. The success of this surgical procedure depends on the ability to eliminate disease from the middle ear (e.g., cholesteatoma and inflamed granulation tissue).
Tympanoplasty is recommended when the eardrum is ruptured (perforated), sunken in (atelectatic), or else abnormal and associated with hearing loss. Tympanoplasty is a safe and effective outpatient procedure. This procedure is usually not needed (or performed) in children under four years of age. There are numerous approaches have been developed and refined as well as a number of grafting techniques are available for the use by the surgeon. The Paramount factors for success of this procedure are the preoperative assessment, good surgical hemostasis and meticulous surgical planning with careful placement of the graft.
What is tympanoplasty?
The tympanic membrane (TM) is a central component of the human ear and is more commonly known as the eardrum. The eardrum divides the middle ear and outer ear canals. The tympanic membrane comprises of three layers of tissue and the outer as well as inner layers consist of epithelium cells. Perforations crop up owing to defects in the middle layer, which contains elastic collagen fibers. Small perforations, more often than not, heal spontaneously. However, when the defect is relatively large, or an infection during the healing process or if there is a poor blood supply, spontaneous healing may be hindered and a surgery is required. Repeated ear infections, trauma (barotraumas, acoustic traumas etc) or injury may cause damage to your eardrum or middle ear bones which can result in increased risk of ear infections and even hearing loss. Eardrum perforations can happen much more frequently in children because of their narrow ear canals and sensitive tissue. The most common cause of eardrum ruptures in children is ear infections. Five in six children will have at least one acute middle ear infection before they’re 3 years old.
Since the introduction of tympanoplasty in the 1950s, different types of graft materials and surgical techniques have been developed and used to close perforations in the tympanic membrane. Tympanoplasty should be performed if the hole in your eardrum is outsized or if you have a chronic ear infection that cannot be cured with antibiotics. You have to stay in the hospital for this surgery and will be placed under general anesthesia.
A surgical cut (incision) is usually made behind the ear or through the ear canal. The eardrum is then lifted up (tympanotomy) to examine the inside of the ear. The surgeon will use a laser to cautiously remove any scar tissue or excess tissue that has developed in your middle ear. Tympanic membrane grafting may be required to graft onto your eardrum to close the hole. The grafts are usually taken from a piece of fascia (tissue under the skin) from the temporalis muscle (behind the ear). Synthetic materials may be used if patients have limited graft availability and have had previous surgeries. The “sandwiching” of the graft material to the native eardrum allows your child’s normal eardrum skin to grow across the hole as the packing material slowly dissolves over the next 2 to 3 months. This surgical procedure typically takes two to three hours.
What is Endoscopic tympanoplasty surgery?
Tympanoplasty is usually performed using a surgical microscope. Initially, endoscopes (long tubes with a camera on the end) were used for paranasal sinus surgeries in otorhinolaryngology practice. It was only in the 1990’s that they were applied in the in otologic surgeries. Like other surgical fields, there is also a trend towards minimally invasive procedures in the field of otorhinolaryngology. Smaller incisions performed using endoscopes are preferred over conventional large incisions. Endoscopic Tympanoplasty prevents the need for an incision in the skin and the endoscope is inserted via the ear canal itself. Once it reaches the eardrum, surgeon ‘lifts’ it and then cut a small graft from the lining of cartilage inside the ear, just in front of the ear canal. Taking the graft here causes much less pain and this graft is then used to patch the eardrum in the usual way.
Endoscopic tympanoplasty surgery has better outcomes and postoperative morbidities can be reduced. Besides, the outcomes of grafts performed using the endoscopic approach is similar to that achieved by the conventional tympanoplasty using microscope. Hence, nowadays endoscopic ear surgery implementations are becoming increasingly popular. However, due to the one-handed nature of the endoscopic surgery, the endoscopic tympanoplasty can be successfully performed only by an experienced surgeon.
Who needs Endoscopic tympanoplasty surgery?
Endoscopic tympanoplasty is more beneficial than the microscopic approach and can be performed in all cases, independent of age including children. It’s also highly beneficial for all those who require minimally invasive, scarless procedure such as persons applying for military /air force services as well as for artists and for Media and Entertainment (M&E) persons. In most cases, tympanoplasty is an elective procedure, meaning that it can be scheduled whenever the patients are ready to have it done. The most significant part of this surgery in children is for their parents for their contribution in restricting the activities of their children as outlined by your surgeon. By following surgeons’ post-operative instructions very closely, you can make sure your child’s result is the best it can be.
Advantages of Endoscopic tympanoplasty
- Endoscopes provide a clear, magnified view of the fine structures in the middle ear cavity
- They do not need large incisions (endaural, postauricular incisions).
- Do not need curettage, range or canalplasty of the external ear canal.
- Compared with microscopic surgery, endoscopic tympanoplasty had shorter operation time.
- Provide less postoperative pain, faster recovery and provide better cosmetic outcomes
- Monitor used during endoscopic surgery provides visual content for training purposes
- Hidden deep regions, such as the hypotympanum,anterior tympanic perforation and facial recess can be directly visualized.
- Contrary to microscopy, views can be obtained from more than one angle.
AUM ENT Clinic, the best ENT clinic Andheri is dedicated to the patients with medical and surgical disorders in the field of Otorhinolaryngology as well as Head and Neck Surgery. AUM ENT clinics are conveniently located at Andheri, Santacruz, Jogeshwari, Vile Parle and Goregaon. AUM ENT clinic prides itself in having the best. Dr Shailesh Pandey is an ENT Specialist doctor and ENT surgeon with more than fifteen years of experience and hundreds of successful surgeries to his credit. He is also the best in eardrum repair treatment India. The clinic offers the best surgical results in the diseases of Ear, Nose and Throat. Be it tympanoplasty surgery Mumbai, other ear surgeries, nose and sinus problems or head and neck surgery, the AUM ENT Clinic results are unparalleled.
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