Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear

Classification

Tympanoplasty is classified into five different types, originally described by Horst Ludwig Wullstein (1906–1987) in 1956. # Type 1 involves repair of the

tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the a ...

alone, when the middle ear is normal. A type 1 tympanoplasty is synonymous to myringoplasty. # Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in the middle ear

ossicles The ossicles (also called auditory ossicles) are three bones in either middle ear that are among the smallest bones in the human body. They serve to transmit sounds from the air to the fluid-filled labyrinth (cochlea). The absence of the auditor ...

. # Type 3 involves removal of ossicles and epitympanum when there are large defects of the malleus and incus. The tympanic membrane is repaired and directly connected to the head of the

stapes The ''stapes'' or stirrup is a bone in the middle ear of humans and other animals which is involved in the conduction of sound vibrations to the inner ear. This bone is connected to the oval window by its annular ligament, which allows the foo ...

. # Type 4 describes a repair when the stapes foot plate is movable, but the crura are missing. The resulting middle ear will only consist of the Eustachian tube and hypotympanum. # Type 5 is a repair involving a fixed stapes footplate. Also called fenestration operation.

Myringoplasty

The term 'myringoplasty' refers to repair of the

alone. There are several options for treating a perforated eardrum. If the perforation is from recent trauma, many ear, nose and throat specialists will elect to watch and see if it heals on its own. After that, surgery may be considered.

Ossicular reconstruction

This procedure is required if there is a damage to the bone chain of the middle ear. Commonly affected bone is the long process of incus, where it gets necrosed. The bone chain can be repaired using autograft of incus or cartilage. Prosthetic implants made of hydroxyapatite or teflon are also used.

Surgical Approach

Tympanoplasty can be performed through the

ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the pinna (anatomy), pinna to the eardrum and is about in length and in di ...

(transcanal approach), through an incision in the ear (endaural approach) or through an incision behind the ear (postauricular approach). A graft may be taken to reconstruct the tympanic membrane. Common graft sites include the

temporalis fascia The temporal fascia covers the temporalis muscle. It is a strong, fibrous investment, covered, laterally, by the auricularis anterior and superior, by the galea aponeurotica, and by part of the orbicularis oculi. The superficial temporal vessels ...

and the tragus. The surgery takes to 1 hour if done through the ear canal and to 2 hours if an incision is needed. It is done under local or

general anesthesia General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...

. It is done on an inpatient or day case basis and is successful 85-90% of the time.

History

The first recorded attempt at repairing the

was made by Marcus Banzer in 1640 using an

ivory Ivory is a hard, white material from the tusks (traditionally from elephants) and teeth of animals, that consists mainly of dentine, one of the physical structures of teeth and tusks. The chemical structure of the teeth and tusks of mammals i ...

tube covered by pig's bladder.

Artificial tympanic membranes

In the middle of the nineteenth century the British otologists James Yearsley and Joseph Toynbee each developed their own form of artificial eardrum. Despite initial enthusiasm for these devices, experience amongst the medical profession over the following half century demonstrated their minimal value in the treatment of a perforated eardrum, which generally heals naturally.Chu, EA and Jackler, RK (2003) The Artificial Tympanic Membrane (1840-1910): From Brilliant Innovation to Quack Device. Otology & Neurotology 24:507-518

References

External links

PERFORATIONS AND HEARING LOSS - Ear Surgery Information Center

Ruptured eardrum: Treatment - MayoClinic.com

- discusses risks of tympanoplasty & related procedures.
Tympanoplasty
- A First hand experience {{Operations and other procedures on the ear Auditory system Ear surgery