Tympanoplasty is the surgical procedure performed to repair eardrum perforation in a child’s ear. Doctors recommend this surgery when the hole in the eardrum fails to close on its own. The eardrum is a thin layer in-ear canal between the outer ear and middle ear that vibrates when sound waves hit it. This membrane helps transfer sound to the inner ear due to which human beings are able to hear. Frequent ear infections, trauma, or surgery can damage this eardrum that needs to be repaired by surgery. If left untreated, it can lead to hearing loss and an increased risk of ear infection.
Eardrum perforation is a hole in the tympanic membrane. This hole can be caused due to several reasons. Most of the time, this perforation doesn’t cause any hearing loss. However, the hearing loss due to perforation depends on the size of the hole and the location of the hole in the eardrum. The majority of the time, these perforations are small and are located in areas that don’t affect the hearing. Additionally, some eardrum holes don’t require any special treatment or tympanoplasty, especially if it is due to an ear infection. The fluid due to infection drains out through the hole and within a few days, the hole closes by itself. When this infection lingers for a long time, then it may require additional treatment.
The doctor recommends the surgical procedure for eardrum repair when a perforation does not cause any drainage or infection and has been present for more than 3 months. In case if perforation is recent, the ENT specialist will wait to see if it heals on its own. If the perforation does not close by itself surgery may be considered.
Types of Tympanoplasty Treatment India
Depending on age and severity of perforation, an ENT specialist will discuss which method is best. There are several approaches to repair an eardrum hole as described by Horst Ludwig Wullstein:
01. Type 1 - It is also known as myringoplasty which involves repair of the eardrum only. In this approach, the doctor uses a gel or paper-like tissue to patch the hole. This procedure takes about 15 to 30 minutes and is done after local anesthesia.
02. Type 2 - Also known as ossiculoplasty, it is performed if any of three tiny bones of the middle ear - ossicles, have been damaged by ear trauma or infections. The damaged bone can be replaced either by using donor bones or prosthetic devices. This approach majorly focuses on the repair of the eardrum and middle ear.
03. Type 3 - This approach is used when there are large defects of the incus and malleus. The epitympanum and ossicles are removed, the tympanic membrane is repaired and connected.
04. Type 4 - It involves a repair when the stapes footplate is movable and the crura are missing.
05. Type 5 - In this approach, a repair involves a fixed stapes footplate.
Tympanoplasty Procedure
Before Procedure
A physical examination by a pediatrician is required within 7 days before surgery. The doctor will ask for a complete medical history. Inform the doctor about the medications and supplements you are taking. If you are not feeling well, inform the doctor about this. In this case, surgery will be postponed. Avoid eating and drinking after midnight before surgery. The medical team will let you know when to arrive at the hospital for the surgery.
During Procedure
Each approach has a different duration, usually, it varies between 10 to 15 minutes or can take up to 2 hours. ENT surgeons will perform this procedure under general anesthesia. The surgeon will first remove any excess tissue or scar tissue from the middle ear with a laser. After this, a small piece of the patient’s tissue, taken from the patient’s own vein or muscle sheath, will be grafted on the eardrum to patch the hole. This procedure will be performed either through an ear canal or the surgeon will make a small incision behind the ear to access the eardrum. The surgeon will use material behind and on top of the eardrum to make sure that graft doesn’t move. This packing material will be dissolved within several weeks. The doctor will fill the ear with cotton packing which should remain in the ear for 5 to 7 days.
After Procedure
The patient will wake up in the recovery room. Most of the patients can go home the same day for the surgery. In rare cases, an overnight stay is required.
Diagnosis of Tympanoplasty Treatment India
Diagnosis of a Perforated Eardrum
The doctor will examine the ear with a lighted instrument called an otoscope to check if there is a hole or tear. Other tests may be asked to assess hearing loss, the extent of damage, and the cause of perforation. These tests include:
01. Tuning fork testing to test hearing
02. Audiology to test hearing in a sound-proof booth
03. Free Field Testing: In this test, the doctor will use his/her voice from different distances and different volumes.
04. Fluid samples from the ear to test for infection.
Signs of Perforated Eardrum
The common symptoms of a perforated eardrum are:
01. Hearing loss, the severity can depend on the rupture.
02. Pain in the ear
03. Discharge of clear, blood, or pus fluid from the ear
04. Ringing or buzzing in the ear
05. Vertigo
06. Air coming out of the ear while blowing nose
Symptoms and Risk factors
Tympanoplasty Recovery
The patient will not be able to hear normally from the operated ear until the packing material is completely dissolved. The full recovery time can be 2 to 3 months. In a first follow-up visit, the doctor will clean the ear canal with a vacuum and inspect the operated eardrum.
There are chances of bloody discharge or drainage from the ear canal, soreness, and ear pain post-surgery. Additionally, one will feel a sharp pain in the ear or will feel like the ear is filled with liquid. There may be clicking, popping, or other sounds in-ear. These will go away after 3 to 5 days of the surgery.
The doctor will give an ear drop; remove the bandage gently and put the drops in the ear as recommended by a doctor. It is advisable to prevent your ear from water during the recovery period. Avoid swimming and while taking bath wear a shower cap. Pat dry the area after showers or baths instead of rubbing. Avoid blowing your nose and use your mouth to sneeze.
Avoid meeting sick people and crowded places. This is due to the reason that catching a cold post-surgery can increase the risk of getting an ear infection. The patient should avoid traveling by airplane until the doctor gives heads up for this. To check the success, a hearing test will be performed again in 8 to 12 weeks post-surgery.
Risks from Tympanoplasty
Minor complications may arise after the procedure. This includes:
01. Bleeding
02. Infection
03. Graft failure
04. No improvement in hearing
05. Dizziness
