What Is Tympanoplasty?

Hearing loss, vertigo (a form of dizziness) facial weakness, otorrhea (discharge from outer ear) and ear pains or aches can all be signs of ear infection or disease that merit a visit to a physician. In most cases, if hearing loss is or exceeds 30 decibels, the physician will suggest tympanoplasty--a surgery "performed to control infection through eradication of disease and to reconstruct the sound conducting mechanism," according to the Baylor College of Medicine. Whether it is left or right tympanoplasty depends on the location of the disease.

Types

• Horst Wullstein developed five types of tympanoplasty depending on the severity of the infection. Type I is called myringoplasty, or an operation to close a hole in the eardrum using a tissue graft. Type II is for perforations in the eardrum with erosion of the malleus, or so-called hammer bone, in the middle ear, and "involves grafting on to the incus [anvil bone] or the remains of the malleus," according to the Baylor College of Medicine. Type III is the grafting of tissue on the stapes, or innermost middle-ear bone, to repair "destruction to the lateral ossicles [small middle-ear bones]." Type VI is used "for ossicular destruction including destruction of all or part of the stapes arch" by grafting tissue "onto or around the mobile stapes footplate." Type V is fixing the stapes footplate completely.

Stages

• Most surgeons prefer to stage surgery, meaning performing the necessary operations, in separate, smaller steps. Tympanoplasty has two stages: the elimination of disease and aeration, or oxygenation, of the middle-ear cleft, and the reconstruction of the sound pressure transfer mechanism.

Aftercare

• Once the surgery is complete, aural hygiene, or hygiene of the ear, is important, as the graft "must remain in contact with the organic matrix or stroma, be free from infection, and not experience shearing forces or excessive tension," according to the Baylor College of Medicine. To achieve this, antibiotic soaking of the aural canal and ear packing should be practiced during recovery. Sneezing with the mouth shut, using a straw to drink, heavy lifting and nose blowing are all strictly prohibited, as pressure will detach the graft.

Complications

• Tympanoplasty is not 100 percent effective; there a guarantee that complications will not arise. Possible complications include hearing loss; facial nerve injury; scarring or adhesions in the middle ear; canal narrowing or stenosis; hollowing of aural ducts or perilymph fistula; erosion, rejection or dislocation of prosthesis; residual or recurrent perforation and lateralization of graft.

  Other nonsurgical related complications include recurrence of cholesteatoma (an expanding sack) or atelectasis (a collapsing sack) of the middle ear space with retraction of the tympanic membrane.

Outcome

• Though most surgeons will quote a 90 percent success rate, that number does not take into account longevity, according to the Baylor College of Medicine. A study by Gordon Smyth showed that over 11 years only 81 percent of tympanoplasty surgeries are successful. This is measured by the "binaural" effect, or the effect to both ears, to the patient "because the operated ear must reach an air conduction level of 30 dB at speech frequencies or be within 15 dB of the other ear for the patient to benefit."