The "Tympanoplasty" surgery, which is performed in eardrum perforations and chronic middle ear diseases, is technically the process of repairing the eardrum and the auditory system in the middle ear, as well as cleaning the inflammation in the middle ear and the mastoid bone behind the ear.
The surgery is the current one. Depending on the extent of the disease, 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).
When is Tympanoplasty Surgery Performed?
Although the patient protects his ear from water and there is no focus of inflammation in the nose and sinus area that will cause ear discharge, if recurrent ear discharge is observed, it will both improve the quality of life and prevent the progression of hearing loss. In order to prevent serious problems due to inflammation, the hole in the membrane must be closed. In these patients, during the same surgery, the hole in the membrane is closed and the problems in the small middle ear ossicles that transmit sound are intervened.
If inflamed tissue called cholesteatoma is detected within the middle ear and mastoid bone and progresses by dissolving the bone, as soon as possible. This inflammation must be removed with surgery. Protecting or repairing the auditory system is the second priority in patients with cholesteatoma, and the main aim is to clear the inflammation without allowing facial paralysis, hearing loss originating from the inner ear, or intracranial complications (meningitis, brain abscess, etc.)
Surgery Technique
When deciding on the technique of the surgery, the condition of the disease, the location of the hole on the membrane, the structure of the ear canal, whether or not the mastoid bone behind the ear will be intervened during the surgery, the surgeon's and finally the patient's preferences are effective.
The middle ear and mastoid during the surgery. Although very different surgical techniques are applied to the bone under the microscope, questions are often asked about this issue because what the patient and their relatives can see about the surgery is limited to the incision in the skin.
Tympanoplasty surgery is performed through the ear canal. It can be performed through incisions made inside the ear or behind the ear. While surgery can be performed through the ear canal without an additional incision just to repair a small hole in the membrane, the approach performed by making an incision through the ear for holes in the middle and back part of the membrane, and behind the ear in holes in the front part of the membrane and in cases where intervention is required in the mastoid bone, is preferred. The main deciding factor in this regard is the preference of the surgeon who will perform the surgery.
The most commonly used tissue in the repair of the eardrum is the sheath of the temporal muscle. Since this tissue is close to the surgical field, it can be easily obtained during surgery. The membrane of the cartilage in front of the ear canal or ready-made materials (materials such as sterile brain membrane pieces that have undergone appropriate processing) can also be used.
When a repair is required to ensure the transmission of sound due to damage to the ossicles that transmit hearing, prostheses made of various materials can be used. Many different materials, such as the pieces obtained from the cartilage in front of the ear canal and the middle ear ossicles themselves, can be used by giving them positions and shapes.
After the Surgery
Patients can usually be discharged from the hospital with dressings on the first day after the surgery. .
In surgeries that do not involve any intervention in the mastoid bone, special sponges in the external ear canal are usually cleaned after 10-14 days, and patients are recommended to protect their ears from water and use ear drops containing antibiotics and cortisone to prevent infections and reactions in the surgery area. In this group, recovery is completed within 3-4 weeks. In general, it is necessary to be protected from influenza infections and strokes and not to travel by plane in the first month. The technical and functional success rate of the surgery in these patients is generally quite good, depending on the extent of the pathology and the pre-operative hearing level.
In patients who have undergone intervention on the mastoid bone during the surgery, various dressings must be applied for varying periods of time depending on the type of surgery performed. Recovery takes longer in this group, and the hearing gain achieved in these patients is generally less than the other group.
Öze Especially if the cholesteatoma is located near the facial nerve and inner ear, bone cannot be scraped in these areas to avoid damaging the nerve and hearing, and disease at the cellular level may be left behind.
Since the risk of recurrence of cholesteatoma is high in patients with this condition, follow-up examinations should be performed at regular intervals after the surgery. . Interventions to repair the auditory conduction system in this group of patients can be performed when the cholesteatoma recurs in small foci or during a second look control surgery to be performed 6-12 months later.
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