What is tympanoplasty surgery?
"Tympanoplasty" surgery, which is performed for chronic middle ear problems, is technically the process of cleaning the inflammation in the middle ear and mastoid bone and repairing the eardrum and hearing system in the middle ear.
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Surgery can be performed depending on the extent of the existing disease, repairing only 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 advanced inflammation in the mastoid bone (mastoidectomy), or a combination of these surgeries. (tympanomastoidectomy).
When is tympanoplasty surgery performed?
In cases where the problem is limited to the hole in the eardrum, only by protecting the ear from water, if inflammation is not observed, it is obvious. If there is no hearing loss and there is no decrease in hearing over time, the surgery to close this hole generally aims to improve the patient's quality of life by eliminating the need to protect the ear from water and to prevent hearing loss that may occur over time, and is performed in line with the patient's preference.
The hole in the membrane is performed. Although the ear is protected from water and 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. In patients with significant 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.
Cholesteatoma within the middle ear and mastoid bone is called cholesteatoma. If inflamed tissue is detected 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 aim is to clear the inflammation before facial paralysis, hearing loss originating from the inner ear, or intracranial complications (meningitis, brain abscess, etc.) occur.
Surgery technique;
Technique of the surgery The condition of the disease, the location of the hole on the membrane, the structure of the ear canal, whether the mastoid bone will be intervened during the surgery, and the surgeon's and finally the patient's preferences are effective when deciding on the surgery. Although the techniques are applied, questions are often asked about this issue because what the patient and their relatives can see about the surgery is limited to the incision on the skin.
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 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 most commonly used tissue in the repair of the eardrum is the sheath of the temporalis 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 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 usually recover after surgery. They can be dressed and discharged from the hospital on the first day.
In surgeries that do not involve any intervention in the mastoid bone, the special sponges inside the ear are usually cleaned after 15-20 days and patients are advised to protect their ears from water and use ear drops 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.
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