TYMPANOPLASTY
Tympanoplasty surgery, which is applied in chronic middle ear problems, is technically the process of repairing the inflammation in the middle ear and mastoid bone and repairing the auditory system in the eardrum and middle ear. The surgery can be performed only by repairing the hole in the eardrum ( Myringoplasty ) according to the extent of the disease, repairing the ossicle system that provides sound transmission in the middle ear ( Tympanoplasty ) , cleaning the inflamed advanced mastoid bone (Mastoidectomy) or a combination of these surgeries (Tympanomastoidectomy).
Is It Necessary To Have Ear Surgery?
In cases where the problem is limited with the hole in the eardrum, if the inflammation is not observed only by protecting the ear from water, the operation is performed according to the patient's preference. Hearing loss in simple membrane holes is around 30% and these patients are not necessarily in the group that should have surgery. On the other hand, in the presence of inflammation that developed cholestoma, melting the middle ear and inner ear bones, there is a possibility of life-threatening problems and these patients must be operated on.
When is tympanoplasty surgery done?
Although the ideal time for simple eardrum replacement surgeries is recommended after 12-14 years of age, it is imperative for patients with advanced inflammation to be operated at any age (sometimes in an emergency).
Under what conditions is tympanoplasty surgery performed and what are the benefits?
Although the ear with a hole in the membrane is protected from water or there is no focus of infection in the nose and sinus region, the hole in the membrane can be closed in order to both improve the quality of life and prevent the development of hearing loss and inflammatory complications. In patients with significant hearing loss, problems in the ossicles that transmit sound can be corrected in the same surgery. Various surgical techniques are available for this purpose. With these techniques, cartilage, bone grafts or middle ear prostheses can be used. If inflammatory tissue called cholestoma in the middle ear and mastoid bone, which progresses by dissolving the bone, is detected, this inflammation should be cleaned with surgery as soon as possible. The protection or repair of the hearing system is the second priority in patients with cholestatoma, the main purpose of which is to remove inflammation without the opportunity of facial paralysis, hearing loss due to inner ear or intracranial complications (meningitis, brain abscess etc.).
How is the Surgical Technique?
When deciding the technique of the surgery, the condition of the disease, the location of the hole on the membrane, the structure of the ear canal, whether or not to interfere with the mastoid bone during surgery, the preferences of the surgeon and finally the patient. Although very different surgical techniques are applied in the middle ear and mastoid bone under the microscope during the operation, questions are frequently asked about this subject since it is limited to the incision in the skin that patients and their relatives can see.
Tympanoplasty surgery can be performed through incisions made through the ear canal, anterior part of the auricle or behind the ear. While only surgery can be performed through the ear canal or the front of the auricle to repair a small hole in the membrane, an incision after the ear is preferred when the mastoid bone needs intervention. The choice of the surgeon who will perform the operation on this matter is the main decision-making factor. The most commonly used tissue for repairing the eardrum is the sheath of the temple. Since this tissue is close to the surgical field, it can be easily obtained during surgery. Although the cartilage or ready-made materials (materials such as sterile ear or cartilage pieces, which have undergone proper treatment) can be used in front of the ear canal, the most reliable and economical method is the patient's own tissues.
How is Medical Care After Surgery?
Patients can usually be discharged from the hospital by dressing on the first day after surgery. In operations that do not intervene in the mastoid bone, special sponges in the ear are usually cleaned after 10-14 days, and patients are recommended to use ear drops containing antibiotics and cortisone to protect their ears from water and prevent infections and reactions in the surgery area. Recovery in this group is completed within 3-4 weeks. In these patients, the technical and functional success rate of the surgery is generally quite good, depending on the extent of the disease and the level of preoperative hearing.
In patients who undergo mastoid bone intervention during surgery, various dressings should be performed at different times depending on the type of surgery performed. Recovery in this group takes longer. Hearing gain in these patients is generally less than the other group. Especially if the cholestomatoma is located adjacent to the facial nerve and inner ear, bone cannot be scraped in these areas in order not to damage the nerve and hearing, and there may be disease at the cellular level. As the risk of recurrence of cholestoma is high in patients with this condition, control examinations should be performed at regular intervals after surgery. In this group of patients, the second glance to be performed 6-12 months later can be performed in the control surgery to detect the cholestatoma early.
What Should I Pay Attention After the Surgery?
In general, it is necessary to dry out especially of flu infections in the first month. In addition, you should be protected from getting a blow to the ear. For this purpose, you should stay away from the sports branches where there is a bilateral struggle and where it is possible to take a blow, as long as your doctor indicates. You should not plug your ear canal with petroleum jelly and miss water until the doctor tells you otherwise. High and low pressure changes should be avoided, for this purpose, road trips that may have altitude changes and especially airplane trips should be avoided for 4-6 months.