Tympanoplasty

Definition: what is a tympanoplasty?

The term tympanoplasty describes a procedure carried out on the ear to close defects in the eardrum and, if necessary, to repair the ossicular chain. The eardrum and the ossicles form a complex mechanical system responsible for conducting sound waves to the inner ear where these are perceived as sound by our sensory cells. Any defects within this system can hinder sound transmission and lead to impaired hearing or even hearing loss.

Indication: when is eardrum surgery performed?

Tympanoplasty is indicated for patients who suffer from impaired hearing due to a perforated eardrum. Additionally, chronic middle ear infections can also arise by an initially defective eardrum. Apart from its role in sound transmission, the eardrum also serves as a mechanical barrier separating the germ-free middle ear from the outer ear canal with its flora.

In special cases, an untreated defective eardrum can lead to a condition known as cholesteatoma. This refers to a benign accumulation of keratinizing epithelial cells that grow though the hole in the eardrum into the middle ear, and result in a chronically purulent middle ear infection involving the adjacent bones.

Due to the above-mentioned complication, it is important to repair a perforated eardrum early on.

Methods: tympanoplasty type 1-3

The different surgical techniques are classified into type 1, 2 and 3 according to the severity of the defect.

Type 1 tympanoplasty is the most minimally invasive variant, whereby only the eardrum is repaired. For this operation, neighboring structures like the auditory ossicles must still be intact. During this operation, the patient's own tissue is removed from the surgical area (usually cartilage, cartilage skin or muscle tissue) and is used as a graft to seal the eardrum defect.

In type 2 tympanoplasty, the ossicular chain has been damaged and therefore simply repairing the eardrum is no longer sufficient. This means that additional parts of the ossicles are substituted with sculpted elements from synthetic material or cement, but the anatomical structure of the ossicles is preserved.

A type 3 tympanoplasty technique is used to reconstruct severely damaged ossicles and therefore either the individual ossicles (partial prosthesis) or the entire chain must be replaced (total prosthesis).

Procedure and duration

Depending on the type of tympanoplasty, the operation can take up to an hour (type 1) or longer (types 2 and 3) and can either be performed under local or general anesthesia. Different approaches can be chosen based on the location and severity of the defect. These may include an incision in front of or behind the earlobe, as well as through the external auditory canal. Often an incision which is several centimeters-long is made behind the earlobe to reach the edge of the eardrum. Next, the surgeon releases the base of the eardrum and folds it over to reveal and remove the defect. To surgically close the defect, the patient's own tissue is removed from the open surgical area so that no further skin cuts are necessary.

To complete the procedure, tamponades are placed in the external ear canal to protect the operated area from germs and to aid in healing. Finally, the incision is sutured closed.

Risks and aftercare

Tympanoplasty is a common procedure in everyday clinical practice and only carries a minimal risk of complications when performed by an experienced surgeon. Usually, these are mild postoperative complaints like soreness, dizziness, and a transient worsening of hearing. However, in rare cases there may be complications such as inflammation, a loss of taste, severe pain, or the rejection of the artificial material (prosthesis).

It is possible that the hearing may not be fully restored even after the operation or may worsen again after some time. A second operation may be required in such cases.

Following the operation, the tamponade remains in the external auditory canal for around 2-3 weeks and is removed during a follow-up outpatient check-up.

The stitches can be generally removed 8 to 10 days after the operation. To ensure smooth healing, patients should take it easy for the first few weeks following the surgery. This means avoiding sports and activities that increase pressure on the ears such as diving.

Which doctors and clinics specialize in tympanoplasty?

The appropriate specialists for tympanoplasty are otolaryngologists (ear, nose, and throat doctors) with a focus on surgery.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of tympanoplasty. They are looking forward to and are ready to address your questions and treatment requests.