Tympanoplasty is the

surgical operation Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

performed to reconstruct hearing mechanism of middle ear

Classification

Tympanoplasty is classified into five different types, originally described by

Horst Ludwig Wullstein Horst may refer to: Science * Horst (geology), a raised fault block bounded by normal faults or graben People * Horst (given name) * Horst (surname) * ter Horst, Dutch surname * van der Horst, Dutch surname Places Settlements Germany * Horst ...

(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 air ...

alone, when the

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles, which transfer the vibrations of the eardrum into waves in the ...

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 auditory ...

. # 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 A perforated eardrum (tympanic membrane perforation) is a hole in the eardrum. It can be caused by infection (otitis media), trauma, overpressure (loud noise), inappropriate ear clearing, and changes in middle ear pressure. An otoscope can be us ...

. If the perforation is from recent trauma, many

ear, nose and throat Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...

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 to the eardrum and is about in length and in diameter. Struc ...

(transcanal approach), through an incision in the ear (endaural approach) or through an incision behind the ear (postauricular approach). A

graft Graft or grafting may refer to: *Graft (politics), a form of political corruption * Graft, Netherlands, a village in the municipality of Graft-De Rijp Science and technology *Graft (surgery), a surgical procedure *Grafting, the joining of plant t ...

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 Local may refer to: Geography and transportation * Local (train), a train serving local traffic demand * Local, Missouri, a community in the United States * Local government, a form of public administration, usually the lowest tier of administrat ...

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 is ...

tube covered by

pig's bladder Pig bladder (also pig's bladder) is the urinary bladder of a domestic pig, similar to the human urinary bladder. Today, this hollow organ has various applications in medicine, and in traditional cuisines and customs. Historically, the pig bladde ...

Artificial tympanic membranes

In the middle of the nineteenth century the British otologists

James Yearsley James Yearsley (1805–1869), aural surgeon, was born in 1805 to a north-country family settled in Cheltenham. Medical career Adopting a medical career, he became a pupil of Ralph Fletcher of Gloucester, (a surgeon of considerable eminence in ...

and

Joseph Toynbee Joseph Toynbee FRS (30 December 1815 Another son, Harry Valpy Toynbee (1861–1941), was the father of universal historian Arnold J. Toynbee, and archaeologist and art historian Jocelyn Toynbee. He died on 7 July 1866, at 18, Saville Row, M ...

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