Tympanoplasty is a type of ear surgery done to patch up the hole in the eardrum. The eardrum, or tympanic membrane, is a thin tissue that divides the middle and outer ear canal. The eardrum allows you to hear as it vibrates when the sound waves enter the ear.
However, if the eardrum is damaged or has a hole in it, it may result in a ruptured eardrum. This can lead to hearing loss. The hole in the eardrum could be congenital or may be caused due to an injury or trauma. Other causes for ruptured eardrums include ear infections, pressure changes, acoustic trauma, and more.
Tympanoplasty surgery is done to reconstruct the hole in the eardrum. The surgery is usually done under general anaesthesia. A tissue graft is taken from the patient, usually behind the ear, and the surgery usually takes around two hours.
Who is best candidate for tympanoplasty surgery
Tympanoplasty surgery is done to repair the hole or tear in the eardrum. The surgery is also done to improve the hearing of a patient. That said, if you meet the following conditions, then you may be considered as a good candidate for tympanoplasty surgery:
- Mucus like or blood drainage from the ear
- Progressive hearing loss
- Nausea or vomiting
- Sharp ear pain that is not treatable with medications
- Optic capsule fistula
- Experiencing tinnitus
- Chronic ear infection
Who should not Consider a tympanoplasty surgery?
The following reasons may not make you a good candidate for tympanoplasty surgery:
- An ear infection that can be treated with medications
- Multiple medical conditions
- Bleeding disorder, anaemia or any other chronic illness
- Blind patients
- No toleration towards anaesthesia
Tympanoplasty surgery preparation
Your doctor may perform different tests to determine the ruptured eardrum. He may perform a physical examination using an otoscope or microscope to check for the hole in the eardrum. The doctor specifies laboratory tests to check for any bacterial infection. The doctor may also perform tympanometry. A device is inserted into the ear canal to measure the eardrum's response to a slight change in air pressure.
Your doctor will explain the tympanoplasty surgery in detail, along with its risk and benefits. The doctor will ask if you take any medications, including over-the-counter drugs, herbs, and vitamins. They will also ask about allergies and the family history of any bleeding disorder. Some other preparation that is required for the surgery includes:
- Wear loose-fitting clothes
- Do not eat or drink anything after midnight, the night before the surgery
- Do not smoke two weeks before the surgery
- Avoid sun damage before the surgery
- Arrange for someone to stay with you and take you home from the hospital after the surgery
- Avoid taking any anti-inflammatory medications two weeks before the surgery
- Discuss the risks, benefits, and alternatives of anaesthesia
- Eat a healthy diet
- Avoid alcohol
During tympanoplasty surgery procedure
Tympanoplasty surgery is done with in-patient hospitalization, meaning that you have to stay for 24 hours in the hospital after the surgery is completed. The surgery is usually done with general anaesthesia. The surgeon can either enter the inner ear via an ear canal (transcanal approach) or by making an incision behind the ear (postauricular approach). The process is done to reach the tympanic membrane perforation. The surgeon then uses two techniques to perform the surgery: underlay or overlay.
In the underlay technique, the graft is placed under the existing eardrum with a foam-like material that easily dissolves after several weeks. The eardrum uses the graft to cover the area of perforation. In the overlay technique, the surgeon removes the eardrum and places the graft to cover all the areas of the eardrum. The skin of the ear canal uses the graft to build a new eardrum. Once the graft is placed in the proper location and held in a foam-like material, the surgeon then sutures the incision and packs it with dressing. The whole surgery usually takes around two years to be completed.
Side effects and complications of tympanoplasty surgery
Tympanoplasty is major surgery, and as with any surgery, there are certain risks like bleeding and infection. However, the complications are relatively rare when it comes to tympanoplasty surgery. Other possible complications include:
- Ringing in the ear
- Graft failure
- Hearing does not improve, or in some cases, it gets worse
- Strange taste in the mouth
- Swelling at the incision site
Care after tympanoplasty surgery
After the tympanoplasty surgery, you may notice some drainage in the first three or five days. You may also feel pain and soreness after the surgery, though it should go away after the first five days of the surgery. Your doctor will prescribe pain medicines to treat the pain. The recovery from the surgery can take two or three months. During the period, the hearing will gradually begin to improve as the packing material dissolves over time. You may be able to go back to your routine after two or three weeks from the surgery. Your surgeon may also ask to follow some precautions, including:
- Avoiding strenuous activities
- Not blow your nose
- Sneeze with mouth open
- Avoid swimming
- Use ear drops as prescribed by the doctor
- Avoid sun exposure for at least one or two weeks
- Avoid wearing clothes that you need to wear over your head
- Elevate the head with a stacked pillow during sleeping
- Avoid using blood-thinning medications
- Gently clean the ear
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