Tympanoplasty

Overview of Treatment

Tympanoplasty is a surgical procedure used to repair structural abnormalities of the middle ear, primarily targeting perforations of the tympanic membrane, damage to the ossicles, or hearing loss caused by chronic otitis media. This surgery reconstructs the anatomy of the middle ear to restore sound conduction, improve hearing, and prevent recurrent infections. Techniques include tissue grafting and ossicular chain reconstruction, suitable for patients with middle ear diseases unresponsive to medication.

Types and Mechanisms of Treatment

Based on the extent and location of the lesion, tympanoplasty can be divided into two main types:

• Indirect Tympanoplasty: Mainly repairs tympanic membrane perforations by transplanting autologous tissue (such as postauricular skin or ear canal mucosa) to restore the integrity of the tympanic membrane while preserving the ossicular chain.
• Direct Tympanoplasty: For patients with ossicular damage, involves removing diseased tissue and reconstructing the ossicular chain, possibly using autologous ossicles or synthetic materials, and repairing the tympanic membrane to restore sound conduction.

Indications

Primarily suitable for the following conditions:

• Perforation of the tympanic membrane due to chronic otitis media unresponsive to medication
• Conductive hearing loss caused by fixation or damage to the ossicles due to infection or trauma
• Congenital middle ear anomalies or recurrent hearing impairment post-surgery

The indication for surgery should be determined by an ENT specialist after otoscopy, audiometry, and imaging assessments.

Usage and Dosage

The procedure is usually performed under general anesthesia, lasting approximately 1-3 hours. The surgeon accesses the middle ear via the ear canal or postauricular incision, performing the following steps in sequence:

• Removing diseased tissue and cholesteatoma to prevent infection spread
• Reconstructing the tympanic membrane using autologous tissue (such as postauricular skin or fascia) or synthetic materials
• If ossicular damage exists, reconstructing the ossicular chain, possibly using autologous ossicles or titanium prostheses

Postoperative care includes regular cleaning and audiometric follow-up.

Benefits and Advantages

The main benefits of this surgery include:

• Significant improvement in conductive hearing loss, with an average hearing gain of 15-30 decibels
• Reduced risk of recurrent otitis media, decreasing the need for long-term antibiotics
• Preservation of natural hearing pathways, avoiding dependence on hearing aids

The success rate of the surgery reaches 80-90%, with good tissue integration and stable long-term hearing outcomes.

Risks and Side Effects

Potential risks include:

• Postoperative infection or hematoma formation, with an incidence of about 1-3%
• Hearing not improving or deteriorating, possibly due to tissue rejection or technical issues
• Dizziness or temporary facial nerve paralysis, most patients recover within weeks

Serious risks: Damage to inner ear structures may lead to sensorineural hearing loss, which is an irreversible complication that must be strictly avoided.

Precautions and Contraindications

Preoperative considerations include:

• Controlling active otitis media before surgery
• Adjusting for patients with severe coagulopathies or uncontrolled diabetes
• Patients with severe temporal bone deformities or cochlear nerve disorders are not suitable candidates

Contraindications: Patients with middle ear malignancies or those who cannot undergo general anesthesia should not have the procedure.

Interactions with Other Treatments

Requires coordination with other medical measures:

• Preoperative antibiotics to prevent infection
• Simultaneous mastoidectomy if mastoiditis is present
• Postoperative nasal steroid sprays to reduce middle ear mucosal edema

Avoid concomitant use with anticoagulants, as it may increase postoperative bleeding risk.

Effectiveness and Evidence

Multicenter studies show:

• Success rate of simple tympanic membrane repair exceeds 90%
• Ossicular reconstruction results in approximately 75-85% hearing improvement at 1 year
• Long-term follow-up over 5 years shows over 80% of patients maintain stable hearing

Surgical outcomes are closely related to surgeon experience and the extent of the lesion, emphasizing the importance of choosing a specialist.

Alternative Options

For patients unable to undergo surgery, consider the following options:

• Hearing aids: suitable for severe hearing loss or surgical contraindications
• Observation: small perforations of the tympanic membrane may heal spontaneously
• Ossicular replacement prostheses: special materials for ossicular implantation as partial reconstruction options

However, these alternatives cannot address structural defects, with surgery remaining the most effective treatment.

 

Frequently Asked Questions

What lifestyle adjustments should be made during the recovery period?

Within 1-2 weeks post-surgery, avoid vigorous activities, heavy lifting, or submerging the ears (such as swimming), and keep the ears dry to prevent infection. Use non-insertive headphones and avoid self-cleaning the ear canal. If ear pain, discharge, or sudden hearing loss occurs, seek medical attention immediately.

What special preparations are needed before surgery?

Preoperative assessment includes detailed ear examination, audiometry, and imaging (such as temporal bone CT) to evaluate ossicular damage and middle ear structure. Patients should stop anticoagulants (like aspirin) at least one week prior and inform the doctor of allergies and chronic conditions.

Is it normal to experience tinnitus or temporary hearing loss after surgery?

Some patients may experience mild tinnitus or fluctuating hearing within weeks after surgery, caused by tissue swelling or temporary ear canal obstruction. Usually, these symptoms improve within 3-6 months. If they persist beyond six months, follow-up evaluation is necessary for possible hearing aids or secondary surgery.

What are the differences between traditional open surgery and endoscopic minimally invasive procedures?

Traditional surgery involves a postauricular incision with a larger wound but a wide visual field; endoscopic procedures are performed through the ear canal, using an endoscope to magnify the image, resulting in less tissue trauma and lower recurrence rates. The choice depends on ossicular damage, cholesteatoma presence, and ear canal width, assessed comprehensively.

How can the time and extent of hearing improvement after successful surgery be estimated?

Hearing recovery time varies; generally, 3-6 months are needed for tissue and tympanic membrane healing. The degree of hearing improvement depends on the severity of initial damage. Mild perforations may recover to normal range, while severe ossicular damage may improve by 30-50 decibels. Follow-up audiometry and otoscopy at 1, 3, and 6 months are essential for assessment.