Repair of Eardrum, Tympanoplasty and Ossiculoplasty

Tympanoplasty (Eardrum and Middle Ear Bone Repair)
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Temporalis Fascial Graft being inserted into the middle ear to close the eardrum perforation.	Gelfoam being inserted under the graft to secure it to the eardrum.
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A tympanoplasty is the repair of the eardrum ( tympanic membrane ) and/or middle ear bones. A tympanoplasty is most commonly performed for repair of the eardrum. Eardrum perforations (holes) are usually caused by trauma or infection. Two methods are commonly done to repair the eardrum.

The first is a myringoplasty which is used to repair a small hole in the eardrum. In this operation, the hole's margin is rimmed, a process which removes skin and tissue, and a small piece of fat is placed into the hole. This operation does not take a long time and in adults can be performed in an office setting under local anesthesia.

The second operation is a formal tympanoplasty. In this operation, the middle ear is entered through a canal skin flap and a piece of muscle tendon or fascia is placed beneath the perforation. This operation is usually performed in the operating room and takes much longer. However, it can close perforations of all sizes and has a higher success rate, than a fat plug. Take a Self Test On Ear Disease and Hearing Loss !!!!
Sometimes a retraction pocket will mimic a perforation. Mouse over the pictures to the left to see the pocket evert with the placement of an ear tube. Click on the picture to enlarge the post-op view.
Complications of tympanoplasty include: Failure of the graft with recurrence of the hole in the eardrum. Recurrence of otitis media with the need to reinsert an ear tube. Cholesteatoma (skin cyst) formation in the middle ear or ear canal. The picture on the right shows a post-op ear after closure of an eardrum perforation. The red arrow shows a myringotomy (ear) tube which was placed to treat recurrent otitis media. The blue arrow shows a mural mural cholesteatoma (skin cyst in the wall of the ear canal). The picture on the left shows the resected cholesteatoma. Click on pictures to enlarge

A tympanoplasty with ossiculoplasty (ear bone repair) is used to repair the middle ear bones. The middle ear bones are often damaged by infection or chronic retraction of the tympanic membrane. Usually, the eardrum is repaired at the same time. Trauma may dislocate the ear bones without creating a hole in the eardrum. In this case, only the ear bones are repaired. The photograph to the right shows an ear bone prosthesis which is used to bridge the gap between the inner ear and the eardrum. Results of replacement of the incus and malleus are around 70%. However, if the stapes is lost the success rate of the operation reported by some authors is under 50% -- see table below. .

Percentage of Patients who had a hearing loss of less than or equal 20 dB after surgery	Type of Prosthesis	Partial Ossicular Prosthesis	Total Ossicular Prosthesis
Gardner et al: Laryngoscope 114: p 65-70, 2004	Titanium	70% N=111	44% N=38
Martin and Harner: Laryngoscope 114: p 61-64, 2004	Titanium	68% N=38	40% N=30
Neff et al: Laryngoscope 113: p 1525-1529, 2003	Titanium	Not Reported	67% N=133

Eardrum Total Ossicular Replacement Prosthesis - TORP

The picture on the right shows the post-operative appearance of an eardrum after a cartridge graft has been placed to fill an attic defect and an ossicular prosthesis used to transmit sound from the eardrum to the inner ear.

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Retracion Pocket and Cartilage Graft for an Ossicular Prosthesis

This picture shows a large cartilage graft, beneath which lies an ossicular prosthesis connection the eardrum to the inner ear. Note that the patient has middle ear negative pressure and a large attic retraction pocket. Middle ear negative pressure is one of the most common reasons for extrusion of the prosthesis.

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The picture on the right shows a prosthesis that was placed in a child who had complete closure of her air bone gap. A year after the operation she developed an ear infection with a distended drum. The prosthesis became dislodged and she developed a 40 dB conductive loss.

This picture on the right-hand picture shows a severely retracted eardrum setting the stage for extrusion of a hydroxyapatite prosthesis.

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This patient had a partial ossicular replacement prosthesis inserted 5 years prior to extrusion. The far right-hand picture shows the hydroxyapatite prosthesis (Applebaum) extruding through the eardrum. Two months later the prosthesis was completely out.

This picture shows a patient with a displaced prosthesis and a perforation in her eardrum which occurred over 2 years after the operation. The patient had a 40 dB conduction hearing loss. Revision surgery to replace the prosthesis and repair the eardrum was recommended.

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Warning!!! ENT USA considers ear candles to be pure quackery and strongly advises that they not be used.

The a picture on the right shows a slipped partial ossicular replacement prosthesis.

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The a picture on the right shows an extruding ear prosthesis.

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Risks of these procedures include failure of the surgery to close the eardrum hole or to improve hearing and numbness of the lateral part of the tongue. Rarely, dizziness and injury to the VII Nerve can occur. The later, can cause a paralyzed face. The VII Nerve courses though the middle ear--see photograph to the right. During these procedures, the surgeon must be careful not to injure this nerve.

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