Tympanoplasty - Eardrum and Middle Ear Surgery
What is tympanoplasty surgery?
"Tympanoplasty" surgery, which is performed for eardrum perforations and chronic middle ear diseases, technically refers to the eardrum and hearing loss in the middle ear. Repair of the system is also the process of clearing the inflammation in the middle ear and the mastoid bone behind the ear.
Surgery, depending on the extent of the existing disease, only repairs the hole in the eardrum (myringoplasty), repairs the ossicle system that provides sound transmission in the middle ear along with membrane repair. (tympanoplasty), cleaning of advanced inflammation into the mastoid bone (mastoidectomy), or a combination of these surgeries (tympanomastoidectomy).
When is tympanoplasty surgery performed? In patients who do not have a hearing loss and who do not have discharge unless water gets into the ear, the surgery to close this hole generally aims to improve the patient's quality of life and prevent hearing loss that may occur over time by eliminating the need to protect the ear from water during bathing and swimming, and is performed in line with the patient's preference.
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, the hole in the membrane must be closed in order to both improve the quality of life and prevent the progression of hearing loss or serious problems due to inflammation. 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.) to occur.
Surgery technique;
Surgery technique;
p>When deciding on the technique of surgery, the condition of the disease should be determined by the size of the hole on the membrane. The location of the attachment, the structure of the ear canal, whether the mastoid bone behind the ear will be intervened during the surgery, and the surgeon's and finally the patient's preferences are effective.
Although very different surgical techniques are applied under the microscope in the middle ear and mastoid bone during the surgery, the patient Since what patients and their relatives can see about the surgery is limited to the incision in the skin, questions are often asked about this issue.
Tympanoplasty surgery 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 without an additional incision to repair only a small hole in the membrane, the approach performed by making an incision behind the ear is preferred for holes in the middle and back part of the membrane, through the ear, for holes in the front part of the membrane and in cases where intervention is required in the mastoid bone. 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 positioning and shaping them.
Post-surgery
Patients can usually be discharged from the hospital with dressings on the first day after surgery. .
In surgeries that do not involve any intervention in the mastoid bone, the special sponges inside the ear 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 during the first month.
During the surgery, the mastoid bone is removed. In patients undergoing intervention, various dressings must be applied for varying periods of time depending on the type of surgery performed. Recovery takes longer in this group. Hearing gain in these patients is generally less than in the other group.
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.
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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.
As a result, there is no standard approach for tympanoplasty surgeries that will suit every patient. In the selection of surgical techniques and applications to be used during surgery, especially in cases with cholesteatoma, the characteristics of the disease and the patient, factors detected during surgery, and the surgeon's experience are often effective.
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