Tympanoplasty is the cleaning of inflammation in the middle ear and mastoid bone and the repair of the eardrum and the hearing system of the middle ear.
✓Tympanoplasty Surgery
The surgery can be performed as repair of only the perforation in the eardrum (myringoplasty) depending on the extent of the existing disease, repair of the ossicular system that provides sound transmission in the middle ear along with membrane repair (tympanoplasty), cleaning of inflammation that has progressed into the mastoid bone (Mastoidectomy), or a combination of these surgeries (tympanomastoidectomy).
✓When is tympanoplasty surgery performed?
In cases where the problem is limited to a perforation in the eardrum, if protecting the ear from water alone does not result in inflammations, there is no significant hearing loss and hearing does not deteriorate over time, tympanoplasty surgery aimed at closing this perforation is generally intended to eliminate the need to protect the ear from water, thus improving the patient's quality of life and preventing hearing loss that may develop over time, and is performed according to the patient's preference.
✓In cases where, despite protecting an ear with an eardrum perforation from water and/or the absence of an infection source in the nasal and sinus region, recurrent ear discharge is observed, closing the perforation in the membrane is a medical necessity in order to improve quality of life and to prevent the progression of hearing loss and the development of inflammation-related complications. In patients with significant hearing loss, in the same surgery, problems in the sound-conducting ossicles should be corrected if possible, and if not possible, the sound transmission system should be repaired using various surgical techniques, cartilage, bone grafts, or middle ear prostheses.
✓When inflamed tissue called cholesteatoma that erodes bone and progresses within the middle ear and mastoid bone is detected, this inflammation must be cleaned through surgery as soon as possible. In patients with cholesteatoma, preservation or repair of the hearing system is a secondary priority, and the main goal is to clean the inflammation without giving an opportunity for facial paralysis, hearing loss originating from the inner ear, or intracranial complications (meningitis, brain abscess, etc.) to develop.
✓Surgical technique
When deciding on the surgical technique, the condition of the disease, the location of the perforation on the membrane, the structure of the ear canal, whether the mastoid bone will be intervened during surgery, the surgeon's preference, and finally the patient's preferences are all influential factors.
✓During the surgery, although many different surgical techniques are applied on the middle ear and mastoid bone under a microscope, since patients and their relatives can only see the incision on the skin regarding the surgery, questions on this topic are frequently asked.
✓Tympanoplasty surgery can be performed through incisions made from within the ear canal, from inside the ear, or from behind the ear. For repair of only a small perforation in the membrane, surgery can be performed through the ear canal, while for perforations in the middle and posterior parts of the membrane, an incision from inside the ear is preferred, and for perforations in the anterior part of the membrane and situations requiring intervention in the mastoid bone, an incision from behind the ear is preferred. In this regard, the preference of the surgeon performing the surgery is the decisive factor.
✓The most commonly used tissue for eardrum repair is the fascia of the temporalis muscle. Since this tissue is close to the surgical field, it can be easily obtained during surgery. The cartilage in front of the ear canal or ready-made materials (materials such as sterile dura mater pieces that have undergone appropriate processing) can also be used.
✓When repair needs to be performed to provide sound transmission due to damage to the ossicles that conduct hearing, prostheses made from various materials, pieces obtained from cartilage in front of the ear canal, and many other materials such as the middle ear ossicles themselves can be used by positioning and shaping them.
✓What Are the Differences Between Tympanoplasty Open and Closed Methods?
Tympanoplasty surgery is generally performed using two main methods: open and closed technique. The open method involves making an incision behind the ear to provide direct access to the eardrum. This method is preferred especially when the eardrum has more significant damage or complications are experienced.
✓Tympanoplasty performed with the open method allows the surgeon to reach the eardrum from a wider area, which is more effective in treating larger or complex perforations. The recovery process after this method may be somewhat longer, but generally provides more permanent results.
✓The closed method, on the other hand, involves surgical intervention through a small incision made from the ear canal. This method is suitable for small perforations in the eardrum or simpler problems. Closed tympanoplasty provides a faster recovery process and generally patients can be discharged the same day.
✓However, in some cases, the closed method may not be as effective as the open method. Although the closed method is preferred due to its minimally invasive nature and short recovery period, in cases of large and complex eardrum damage, the open method may generally be more successful.
✓Which Type of Tympanoplasty Is Applied in Which Situations?
The type of tympanoplasty is determined based on the size of the damage to the eardrum and the patient's health status. Closed tympanoplasty is generally suitable for patients with small and simple perforations in the eardrum or mild hearing loss. Since this method is less invasive, the recovery time is also faster and patients can generally return to their daily activities within a few days.
✓However, if there are large perforations in the eardrum, prolonged infections, or complications, open tympanoplasty may be preferred. The open method allows the surgeon to reach the eardrum from a wider area and more effective results are obtained in more complex cases.
✓Additionally, microsurgical tympanoplasty may also be preferred in some cases. This method uses advanced surgical techniques to repair damage to the eardrum with greater precision and is performed with microsurgical instruments.
✓What Are the Differences and Success Rates Among Tympanoplasty Surgery Types?
The fundamental differences among tympanoplasty surgery types lie in their application techniques and recovery times. Closed tympanoplasty is generally applied for small eardrum perforations and the recovery process is fast. Success rates in this type are high because the procedure has low invasiveness and complication risk is low. However, this method may not be sufficient for larger or more complex perforations.
✓Open tympanoplasty is generally preferred for large and complex eardrum damage. The success rate of this method is also quite high because it provides the surgeon with access to the eardrum from a wider area and allows for the repair of larger damage. However, the recovery process after this method may be somewhat longer and patients generally require several weeks of rest after surgery.
✓Microsurgical tympanoplasty is a technique that requires a more precise approach and is especially suitable for situations that require fine workmanship in membrane repair. Success rates in this method are generally very high because even the smallest types of damage to the eardrum are treated with great precision.
✓However, microsurgical tympanoplasty requires more experience and the surgeon's expertise directly affects success rates.
✓In general, among tympanoplasty types, open methods are used in more complex cases, while closed and microsurgical methods are options that offer less invasiveness and faster recovery opportunities. Although success rates are high in each type, the type of surgery and the patient's condition may affect treatment success.
✓Which Age Groups Are Suitable for Tympanoplasty Surgery?
Tympanoplasty surgery is generally considered a suitable surgical intervention for children aged 6 years and older and adults. The most appropriate age range for children is around 6-7 years of age, when the ear structure has begun to develop completely and the perforation in the eardrum should be treated before it becomes a serious health problem.
✓However, below this age, the size and structure of the eardrum may increase the difficulties of surgery. In adults, tympanoplasty can be performed considering the size and cause of perforations in the eardrum. In children, early intervention is more beneficial in terms of faster healing of perforations in the eardrum and reducing infection risk.
✓However, any patient in any age group experiencing hearing loss due to a perforation in the eardrum should know that if left untreated, this condition can lead to permanent hearing loss. Tympanoplasty surgery is an appropriate option for all age groups, especially for ensuring a healthy recovery process and preventing complications.
✓What Tests Should Be Performed Before Surgery?
Before tympanoplasty surgery, several tests are performed to evaluate the patient's ear structure and general health status. First, an audiometry test (hearing test) is performed. This test determines the degree of hearing loss in the patient and clarifies the necessity of surgery. Additionally, examination of the eardrum and inspection of the internal ear structure is also important.
✓Through this examination, the size, shape, and cause of the perforation in the eardrum are determined. Tests such as tympanometry and audiometry help assess the functions of the eardrum and middle ear. These tests show whether there are any other structural abnormalities that might affect the healing of perforations in the eardrum. Additionally, blood tests of the patient may also be performed.
✓Blood tests provide information about infection risk, suitability for anesthesia, and general health status. If the patient has other health problems, these conditions should also be considered. These tests are necessary for surgery to be performed safely and successful results to be achieved.
✓How Long Does Tympanoplasty Surgery Take?
Tympanoplasty surgery generally takes 60–120 minutes. When eardrum repair, tympanoplasty surgery, and eardrum surgery techniques are applied together, a safe and effective surgical process is provided throughout the surgery. During surgery, eardrum repair, tympanoplasty surgery, and eardrum surgery techniques carefully protect both the middle ear, eardrum, and surrounding tissues. Regular follow-up and recommended care with eardrum repair, tympanoplasty surgery, and eardrum surgery optimize healing and reduce complication risk.
✓Does Tympanoplasty Surgery Cause Pain?
Pain following tympanoplasty surgery is generally mild to moderate and is controlled with painkillers recommended by the doctor. When eardrum repair, tympanoplasty surgery, and eardrum surgery are applied together, both post-operative comfort and healing are safely provided. Mild pain and irritation during the first few days with eardrum repair, tympanoplasty surgery, and eardrum surgery techniques are considered normal. Regular follow-up and care with eardrum repair, tympanoplasty surgery, and eardrum surgery accelerate healing.