Tympanoplasty is surgery to treat ruptured eardrums. Eardrum rupture refers to having a hole in your eardrum that affects your ability to hear. The eardrum is a thin layer of tissue that vibrates in response to sound. Your healthcare provider may treat your ruptured eardrum with ear drops or antibiotics. If this doesn’t work, you may need a tympanoplasty, to patch the hole in your eardrum.
What is tympanoplasty surgery?
Your eardrum is the tissue separating your ear canal and your middle ear, which can be damaged. Tympanoplasty is surgery to treat ruptured eardrums. If left untreated this hole in your eardrum tissue will affect your hearing ability. Many times your healthcare provider will treat your ruptured eardrum with ear drops or antibiotics. But if your eardrum doesn’t heal after two or three months, you may need tympanoplasty surgery to prevent problems like hearing loss, chronic infections, and dizziness.
What causes ruptured eardrums?
Having middle ear infection (otitis media).
Poking your eardrum while cleaning your ear with a cotton swab, bobby pin, pencil, or another object.
Ear injuries are caused by a loud explosion, a fractured skull, or taking a hard hit on the side of your head.
Developing barotrauma, a condition that can happen when your eardrum is affected by sudden changes in air pressure.
Who might need tympanoplasty surgery?
Tympanoplasty is a surgical procedure used to repair a perforated tympanic membrane, also known as the eardrum, and to improve hearing. This surgery is often recommended when the perforation in the tympanic membrane is large or does not heal on its own. The eardrum plays a crucial role in our hearing by vibrating in reaction to sound. A small hole may not significantly affect hearing, but a larger one or one in a particular area of the eardrum may cause hearing problems.
There are several reasons why an individual might need tympanoplasty surgery. Persistent hearing loss and drainage from the ear (otorrhea) are signs that the eardrum is not healing, indicating the need for tympanoplasty. Both adults and children can get a hole in the eardrum from various causes, including head trauma, repeated or severe ear infections, surgery such as the placement of ear tubes, cholesteatoma (skin cyst in the ear), or inserting something into the ear canal, such as a cotton swab. A sudden change in pressure, such as from a wave slapping the eardrum or a blast injury, can also cause a perforation.
Children are more likely than adults to develop ear infections, to receive ear tubes, or to insert things in their ears, making them more likely to have eardrum perforation that needs tympanoplasty. In addition to repairing the eardrum, tympanoplasty can also be performed to correct related problems in the middle ear. These procedures include ossiculoplasty (reconstruction of the ossicles, which are the tiny bones in the middle ear) to fix the connections among the ossicles, which are attached to the eardrum and help amplify sound. The three ossicles are named malleus, incus, and stapes.
What happens before tympanoplasty?
Before surgery, your middle ear and hearing will be examined. These steps include:
Examining the head and neck.
Examine the middle ear and eardrum with a microscope or otoscope so they know the location and size of your rupture, whether your eardrum is discharging any fluid or is dry, and if there are signs of inflammation.
Audiometry test, which checks whether you can hear different sounds and pitches, and tympanometry, which checks how well your middle ear functions.
What are the different tympanoplasty techniques?
Every tympanoplasty technique aims at patching your ruptured eardrum. The techniques differ in how your healthcare provider reaches your middle ear to repair your eardrum. These techniques include:
Postauricular tympanoplasty: A curved incision is made behind your auricle, which is the crease in your outer ear.
Endaural: An incision is made above your ear canal.
Transcanal: Your middle ear is reached through your ear canal. Used in cases where the hole is relatively small and located in the back of the eardrum.
Tympanoplasty Complications and Side Effects
Tympanoplasty is a surgical procedure performed to repair a perforated tympanic membrane or eardrum and improve hearing. Just as with any surgical procedure, tympanoplasty carries potential complications and side effects.
Failure of the repair graft: This is one of the most common. It can result in the perforation not healing properly, necessitating further treatment or surgery. There’s also a risk of infection, which can occur in any surgical procedure. Infections can usually be treated with antibiotics but may cause discomfort and delay the healing process.
Hearing loss: While the goal of the surgery is to improve hearing by repairing the eardrum, in some cases, patients may experience worsened hearing after the procedure. This could be due to several factors, including damage to the small bones in the middle ear (ossicles) during surgery.
Tinnitus (Ringing in the ear): This can be a temporary or permanent condition and can be quite distressing for patients. Dizziness is also a common side effect after surgery, usually subsiding several hours after the procedure.
Nerve damage: In rare cases, tympanoplasty can result in facial paralysis due to nerve damage. The facial nerve runs very close to the ear, and any surgery in this area carries a risk of nerve damage. This is a serious complication and can result in weakness or paralysis on one side of the face.
Dryness in mouth: Another potential side effect is a change in taste or dryness in the mouth. This is because the nerve that supplies taste to the front two-thirds of the tongue (the chorda tympani) runs through the middle ear and can be affected by ear surgery.
While these complications and side effects can occur, it’s important to note that tympanoplasty is generally a safe procedure with a high success rate. The potential benefits of improved hearing and quality of life often outweigh the risks. However, all potential risks and complications should be discussed with the surgeon before the procedure.
What Happens During Tympanoplasty?
For a tympanoplasty, patients will be put under general anesthesia. An incision will be made above or behind your ear or by going through your ear canal. A small piece of tissue called temporalis fascia will be obtained to create the graft or patch. Next, your provider reaches your eardrum. They lift it to place graft material underneath your eardrum. Your provider then places foam over your eardrum to hold the graft in place while your eardrum heals. Over time, your eardrum grows new tissue, using the graft material as the foundation. Then the incisions will be closed.
Tympanoplasty aftercare
It can take 10 days to two weeks for you to recover from tympanoplasty. Plan on taking it easy during that time. The surgery team will give you care instructions; you may need to:
Avoid nose-blowing
Sneeze with the mouth open
Avoid getting water in the ear
Use ear drops, if prescribed
Patients may experience some mild ear pain following surgery which will get better with pain medication. It’s normal to feel fullness in the ear or experience a small amount of blood or fluid draining from the ear. Any packing placed in the ear will dissolve over time, but anything left will be removed at the 2-3 weeks post-op visit to your doctor. Patients can expect hearing improvement over 2-3 months after surgery. Patients will be given hearing tests 8-12 weeks after surgery.
Tympanoplasty Recovery
The recovery process following tympanoplasty is crucial for the success of the surgery and the restoration of hearing. This period can vary depending on the individual and the extent of the surgery, but it generally takes between 10 days to two weeks. During this time, patients are advised to take it easy and follow the at-home instructions provided by their healthcare provider. Immediately after the surgery, patients may experience some pain and discomfort, which can usually be managed with over-the-counter pain relievers or prescription medications. Some patients may also experience dizziness or a change in taste, which should gradually improve over time.
Patients are typically advised to keep their ears dry to prevent infection. This means avoiding swimming and being careful while showering or washing hair. It’s also important to avoid blowing the nose forcefully as this can disrupt the healing process. Follow-up appointments with the healthcare provider are essential to monitor the healing process. During these visits, the healthcare provider will examine the ear to ensure that the eardrum is healing properly and that there are no signs of infection.
Hearing improvement is one of the main goals of tympanoplasty, and patients may notice an improvement in their hearing once the ear has healed. However, the full extent of hearing improvement may not be apparent until several weeks or even months after the surgery. While the recovery process can be challenging, most patients find that the benefits of improved hearing and reduced symptoms of ear discomfort or infection are well worth it.
Conclusion
Tympanoplasty is a surgical procedure that plays a crucial role in treating conditions related to the eardrum and middle ear, primarily aiming to improve hearing and quality of life. While the surgery carries potential risks and complications, such as infection, hearing loss, tinnitus, and in rare cases, facial paralysis, it is generally considered safe with a high success rate. The recovery period is an essential phase where patients are advised to follow specific guidelines to ensure successful healing. Despite the challenges that may arise during the recovery process, the benefits of tympanoplasty, including improved hearing and reduced symptoms, often outweigh the risks. Patients need to have open communication with their healthcare provider to address any concerns or questions during the recovery process. Ultimately, tympanoplasty represents a significant advancement in medical procedures aimed at resolving ear-related issues.