Tympanoplasty

Tympanoplasty surgery is technically the process of cleaning the inflammation in the middle ear and mastoid bone and repairing the eardrum and auditory system in the middle ear. It can be performed only by repairing the hole in the eardrum (myringoplasty), repairing the ossicle system that provides sound transmission in the middle ear along with membrane repair (tympanoplasty), cleaning the inflammation that has progressed into the mastoid bone (mastoidectomy), or a combination of these surgeries (tympanomastoidectomy).

Should I have tympanoplasty surgery?

In case of inflammation in the ear or permanent hole in the eardrum In this case, we recommend this surgery. Although the ear with a hole in the membrane is protected from water and or there is no focus of infection in the nose and sinus area, in case of recurrent ear discharge, it is a medical necessity to close the hole in the membrane in order to both improve the quality of life and prevent the progression of hearing loss and inflammation-related complications. Evident hearing loss If it is not possible to correct the problems in the ossicles that transmit sound in the same surgery, the sound conduction system should be repaired using various surgical techniques, cartilage, bone grafts or middle ear prostheses.

If inflamed tissue called cholesteatoma is detected within the middle ear and mastoid bone and progresses by dissolving the bone, this inflammation must be removed with surgery as soon as possible. Protecting or repairing the auditory system is the second priority in patients with cholesteatoma, and the main goal is to clear the inflammation before facial paralysis, hearing loss originating from the inner ear, or intracranial complications (meningitis, brain abscess, etc.) occur.

How is the surgery done?

During surgery, many different surgical techniques can be applied to the middle ear and mastoid bone under a microscope. Tympanoplasty surgery It can be performed through incisions made through the ear canal, inside the ear or behind the ear. While surgery can be performed through the ear canal to repair only a small hole in the membrane, an incision is preferred through the ear for holes in the middle and back part of the membrane, and behind the ear is preferred for holes in the front part of the membrane and in cases where intervention is required in the mastoid bone. In this regard, the choice of the surgeon who will perform the surgery is the main deciding factor.

The tissue most commonly used to repair the eardrum is fascia or cartilage. Since this tissue is close to the surgical field, it can be easily obtained during surgery. We do not prefer artificial materials. When a repair is needed to ensure the transmission of sound due to damage to the ossicles that transmit hearing, many different materials can be shaped and used, such as prostheses made of various materials, pieces obtained from the cartilage in front of the ear canal, and the middle ear ossicles themselves.

Postoperative

Patients can usually be dressed and discharged from the hospital on the first day after surgery. Then, dressings are applied at decreasing intervals. There is no standard approach for tympanoplasty surgeries that will suit every patient. The selection of surgical techniques and applications to be used during surgery, especially in cases with cholesteatoma, is often determined by the characteristics of the disease and the patient, factors detected during surgery, and the experience of the surgeon.

The study we conducted in 2011 below shows the good results we obtained in eardrum repair surgery performed with cartilage.

Comparison of Perichondrium-Cartilage Island Graft and Temporal Muscle Fascia in Type 1 Tympanoplasty

Dadaş B., Korkut Y., Sözen E., Coşkun U. B., Tansuker D. H., Uçak O. Y.

Introduction Graft materials used during tympanoplasty vary. Temporal muscle fascia has become the most commonly used material today. In recent years, cartilage tympanoplasty performed using tragal or conchal cartilage has become popular. In this study, the effects of tympanoplasty performed using temporal muscle fascia and conchal and tragal perichondrium-cartilage island graft on eardrum healing and hearing were examined. Method A total of 79 patients, 55 women (69.6%) and 24 men (30.4%), who underwent primary tympanoplasty type 1 operation using temporal muscle fascia or pericondium-cartilage island graft in our practice between January 2007 and January 2010, were retrospectively examined. . The average age of the patients was 33.05 (15-59). Patients with subtotal perforation, normal middle ear mucosa, and intact ossicular chain were included in the study. Temporal muscle fascia graft was applied to 36 (45.6%) of the patients, conchal perichondrium cartilage graft was applied to 17 (21.5%), and tragal perichondrium cartilage graft was applied to 26 (32.9%). Preoperative and postoperative eardrum examination records were reviewed. Pure tone threshold averages and air-bone conduction patency values at four frequencies (0.5, 1, 2 and 4 kHz) were evaluated before and 12 months after the operation. Finding: The rate of closure of tympanic membrane perforation was 80.6% in the patient group where temporal fascia was used, 100% in the group where conchal cartilage was used, and 88.5% in the tragal cartilage group. The average pure tone threshold values obtained before and after the operation were determined as 30.4 and 23.6, respectively, for the temporal muscle fascia, 27.8 and 21.5 in the conchal cartilage group, and 25.5 and 20.7 in the tragal cartilage group. Preoperative and postoperative air-bone conduction gaps were determined as 17.6 and 11.9 for the temporal muscle fascia group, 17.5 and 8.6 for the conchal cartilage group, and 19.1 and 9.4 for the tragal cartilage group, respectively. Discussion and Conclusion The aims of tympanoplasty are to provide an intact eardrum and good hearing. The use of cartilage grafts in tympanoplasty has been recommended in patients with lower chances of success, such as subtotal or total perforations, tympanosclerosis and revision cases. In our study, we found the use of both tragal and conchal cartilage as graft materials to be more successful than temporal fascia. The use of perichondrium-cartilage island graft increases the chance of success in large tympanic membrane perforations.