Tympanoplasty

Overview of Treatment

Tympanoplasty is a surgical procedure used to repair abnormalities of the middle ear structures, primarily targeting tympanic membrane perforations, ossicular chain damage, or hearing loss caused by chronic otitis media. This surgery reconstructs the anatomical structures of the middle ear to restore sound conduction, improve hearing, and prevent recurrent infections. Techniques include tissue grafting and ossicular chain replacement, 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 reconstruct the tympanic membrane while preserving the original ossicular chain structure.
• Direct Tympanoplasty: For patients with ossicular damage, involves removing diseased tissue and reconstructing the ossicular chain, possibly using autologous ossicles or artificial materials, and repairing the tympanic membrane to restore sound conduction.

Indications

Primarily suitable for the following conditions:

• Chronic otitis media with tympanic membrane perforation unresponsive to medication
• Ossicular fixation or damage caused by infection or trauma, resulting in conductive hearing loss
• Congenital middle ear anomalies or recurrent hearing impairment post-surgery

Surgical indications should be assessed by an ENT specialist after otoscopy, audiometry, and imaging evaluations.

Usage and Dosage

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

• Remove diseased tissue and cholesteatoma to prevent infection spread
• Use autologous tissue (such as postauricular skin, fascia) or synthetic materials to repair the tympanic membrane
• If ossicular damage exists, reconstruct 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 include:

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

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

Risks and Side Effects

Potential risks include:

• Postoperative infection or hematoma, 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 cause sensorineural hearing loss, which is an irreversible complication that must be strictly avoided.

Precautions and Contraindications

Preoperative considerations include:

• Controlling infection during acute otitis media episodes
• Adjusting for patients with severe coagulation disorders or uncontrolled diabetes before surgery
• Patients with severe temporal bone deformities or vestibulocochlear nerve pathology are unsuitable for this procedure

Contraindications: Patients with middle ear malignancy or contraindications to general anesthesia should not undergo the procedure.

Interactions with Other Treatments

Requires coordination with the following medical measures:

• Preoperative use of antibiotics to prevent infection
• Concurrent mastoidectomy if mastoiditis is present
• Postoperative use of nasal corticosteroid sprays to reduce middle ear mucosal edema

Avoid combining 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 75-85% hearing improvement at 1 year
• Long-term follow-up over 5 years shows over 80% of patients maintain stable hearing

The surgical outcome is closely related to the surgeon’s experience and the extent of the lesion, and should be performed by 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 tympanic membrane perforations may heal spontaneously
• Ossicular prostheses: special implant materials can serve as partial reconstruction options

However, these alternatives cannot address structural defects and surgery remains the most effective treatment.

 

Frequently Asked Questions

What lifestyle adjustments should be made during the recovery period after surgery?

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

What special preparations are required before surgery?

Preoperative assessment includes detailed ear examination, audiometry, and imaging (such as temporal bone CT) to evaluate ossicular damage and middle ear structures. Patients should discontinue anticoagulants (such as 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 due to tissue swelling or temporary ear canal blockage. Usually, these symptoms improve within 3 to 6 months. If they persist beyond six months, further evaluation for hearing aids or secondary surgery may be necessary.

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

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, which minimizes tissue damage and recurrence rates but requires experienced surgeons. The choice depends on ossicular damage, cholesteatoma presence, and ear canal width.

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

Hearing recovery varies among individuals, typically taking 3 to 6 months for complete healing of grafts and the eardrum. The degree of improvement depends on the severity of initial damage; minor perforations may restore normal hearing, 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.