Information on Ear, Nose and Throat Surgeries Eardrum and Middle Ear Surgery (Tympanoplasty and Ossiculoplasty)
Eardrum & Middle Ear Surgery - Tympanoplasty
Eardrum & Middle Ear Surgery
 
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Tympanoplasty (Eardrum and Middle Ear Bone Repair)
 
Search PubMed for Tympanoplasty   Search PubMed for Eardrum Perforation    

For Doctors:  View Slide Show on the Surgical Technique of Tympanoplasty   Thirty slides of an actual surgical operation with explanation of each surgical step. (Presentation for I-Pad, Android & Computers) - Not suitable for all viewers !!  

Download PowerPoint PDF on Eardrum Repair (Tympanoplasty)

  
   

 

  
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Eardrum Repair - Temporalis Fascia Graft Placement in Middle EarTemporalis Fascial Graft being inserted into the middle ear to close the eardrum perforation.
View Video

Eardrum Repair - Gelfoam Placement in Middle Ear 
Gelfoam being inserted under the graft to secure it to the eardrum.
View Video


Video:  View Tympanosplasty & Keratoma Resection - 9 mins 
  
Video: View Tympanoplasty - Underlay Technique - Endaural Approach - 8.5 mins
  
Video: View Tympanoplasty (Eardrum Repair) - Post Auricular Apporach - 7.75 mins

  

      

  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.  
 

Eardrum Hole 

Small Eardrum Perforation
Before Surgery
Eardrum Perforation Closed With A Fat Plug Myringoplasty 

Eardrum Perforation
Closed With a Fat Plug
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. 

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Eardrum Perforation


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. 

Mural Cholesteatoma - Surgical SpecimenThe 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

 

Mural Cholesteatoma

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
  
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.

Click on pictures to enlarge

  
Retracion Pocket and Cartilage Graft for an Ossicular ProsthesisThis 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.  

Click on pictures to enlarge


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

 

Click on pictures to enlarge


Extruding Applebaum ProsthesisExtruded Applebaum ProsthesisExtruded Applebaum ProsthesisThis 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.

Click on pictures to enlarge



Warning!!! ENT USA considers
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The a picture on the right shows a slipped partial
ossicular replacement prosthesis
 

Click on pictures to enlarge


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

Click on pictures to enlarge
 
  
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.


Click on pictures to enlarge

 
 

  
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