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MIDDLE EAR REPAIR - TYMPANOPLASTY

Why is Middle Ear Repair performed ?

There are two main reasons for performing tympanoplasty. The first is to correct certain types of deafness, the second is to prevent infection getting into the middle ear from outside. Successful closure of a perforation allows the patient to swim and to get water in the ear without causing infection.

Preparations needed for Middle Ear Repair

The patient will be admitted to hospital for an operation, usually under a general anaesthetic. The time in hospital varies according to the exact nature of the operation: between a few hours and 1 day.

What Happens during Middle Ear Repair

Tympanoplasty is an operation to repair a fault in the middle ear sound conducting mechanism. In the normal ear, sound waves are collected by the outer ear and pass down the ear canal. The energy of the sound waves makes the ear drum vibrate. This vibration is transmitted to the little bones of the middle ear. These bones (ossicles) are three in number and form a bridge to the inner ear. They are called the malleus (hammer), incus (anvil) and stapes (stirrup). The malleus is fixed to the drum and the stapes joins the inner ear. The vibrations move the little bones and this movement stimulates the inner ear nerve endings which send signals to the brain. This mechanism of transfer of sound energy to the inner ear may be blocked in a number of ways. The commonest problem is the perforation or hole in the ear drum. An operation simply to repair the perforation in an ear drum is called a myringoplasty . This is the simplest type of tympanoplasty. When a defect in the ossicles of the middle ear is corrected the operation is called an ossiculoplasty . A tympanoplasty may involve either or both procedures and also, on occasion, exploration of the mastoid. The mastoid is an air cavity which is very close to the middle ear. Various techniques and materials may be used to repair the bony defects which may be found. Some will involve the patient's own tissues and others will involve synthetic material. The surgeon may need to make an incision behind or in front of the ear to obtain a satisfactory view of the area. The repair of the ear drum is usually done by grafting with tissue from the covering of a muscle near the ear. This tissue is usually obtained through an incision just within the hairline. The perforation site is prepared for the graft under an operating microscope. The graft is carefully placed in position using very fine instruments.

Possible Complications during Middle Ear Repair

Deafness occurs in a very small number of cases (much less than 1%). It is a risk which is present in all middle ear surgery. Giddiness is usually very slight or absent. Infection, causing earache and discharge, rarely occurs. However, it is one of the main causes of failure of these operations.

After Middle Ear Repair

In the immediate post-operative period there is very little in the way of pain and this is easily relieved by tablets. Some degree of giddiness may be present and is easily controlled with medication. You will be rapidly mobilized and instructed not to blow your nose hard and, if possible, to avoid sneezing. Both these actions may interfere with the middle ear repair. There is usually a small pack left in position in the ear canal and this is removed a few days after surgery. Sutures are usually left in for a week. It usually takes several weeks to decide whether the operation has been successful or not. Final assessment of success of the operation.

If Middle Ear Repair is not performed

The deafness would persist and the risk of introducing middle ear infection would remain.