Procedure for Endoscopic Tympanoplasty

Endoscopic Tympanoplasty

Endoscopic tympanoplasty is the procedure to repair the perforated eardrum (a ruptured eardrum) which causes sudden hearing loss; an endoscope is used in this procedure instead of a microscope. The three small bones of the middle ear the ossicles the malleus, incus, and stapes can also be involved in the procedure.

The following are the most common causes of eardrum perforation:

• Injury/trauma
• Acute and chronic infections
• Tumours
• Excessive noise pollution
• Birth defect
• Old age
• Hearing loss
• Tinnitus

The Tympanic Membrane

Small ruptures in the eardrum (perforations) heal on their own but bigger perforations involving a large area of the three layers along with infection causes improper healing and in which cases tympanoplasty surgery would have to be performed. At times tympanic membrane grafting is done. Grafts are usually obtained from:

• Veins
• Fascia
• Synthetic material

Tympanoplasty Procedure

The different types of procedures are suggested based on the condition of the patient, the main types of procedures are:

• Type I Tympanoplasty

  This involves the restoration of the perforated eardrum by grafting.

• Type II Tympanoplasty

  This involves the restoration of the tympanic membrane perforations with erosion of the malleus.

• Type III Tympanoplasty

  This takes place when tympanic membrane is perforated along with destruction of two ossicles, with the stapes still intact and mobile.

• Type IV Tympanoplasty

  This takes place when ossicular destruction involves all the three bones.

• Type V Tympanoplasty

  This takes place if the footplate of the stapes bone is fixed.

Tympanoplasty, depending on the severity of damage, is done under local or general anesthesia. In small perforations of the tympanic membrane, surgery is performed under local anesthesia with IV sedative.

Preparation For Procedure

Before going for the tympanoplasty procedure, you need to go through some tests, which give a health update to your surgeon. Certain tests are done before the procedure such as

• History of the hearing loss
• History of vertigo
• Complete ear testing of the ear
• X ray
• An audiogram
• Otoscopy
• Facial weakness/paralysis
• Blood and urine tests

Statistics

Hearing loss effects across ages, however, it increases with age. Causes of hearing loss: genetic 4 %, ear injury 8%, high decibels sounds 37%, ear infection 18 %, old age 32 %.

What is the Average Length of Stay For This Surgery?

The patient has to be admitted a day before the surgery. It is a short duration surgery of about two -three hours. The patient is discharged the same day.

Advantages of Endoscopic Surgery

Advance technology has been immensely helpful for medical field. It has reduced the patients’ money, time and faster recovery too. The following are the advantages of endoscopic surgery:

• The procedure has 90% success rate
• Better surgical view
• Minimum invasive surgery, lesser size of incisions
• Lesser chance of injury
• Shorter duration of surgery
• Better visualization of middle ear cavity
• Less post-surgical pain and complications

Disadvantages

The disadvantages of Endoscopic surgery are:

• Less efficient when only one-hand surgery is done
• If massive bleeding occurs the view from the endoscope is stained by blood and procedure becomes difficult.
• Direct injury can be caused by the endoscope itself.
• Thermal damage by the endoscopic light can be caused.

Indications

The procedure is indicated in:

• Injury/trauma
• Acute and chronic infections
• Tumors both benign and malignant
• Excessive noise pollution
• Birth defect
• Old age
• Any age is safe

Contraindications

• Active infections
• Active bleeding
• Any uncontrolled chronic illness like diabetes.

Complications

Immediate and delayed complications are as follows:

• Graft failure
• Recurrent perforations
• Narrowing of the ear canal
• Scarring / adhesions in the middle ear
• Fistula formation
• Hearing loss
• Erosion of prosthesis
• Dislocation of the prosthesis
• Facial nerve injury
• Tinnitus and continuous echo type noises

Post-operative Care

The patient is advised the following:

• In two-three hours patient can return home
• Antibiotics/ear drops and pain killers are prescribed for about a week.
• Pain killers are prescribed
• Ear packing is removed after 10 days and the graft is evaluated.
• Ear should be kept dry.
• Do not blow nose.
• Hearing test is done.
• Tympanoplasty recovery takes around 3 to 4 weeks.