Tympanoplasty
is the name given to the family of
operations that repair the tympanic
membrane and the middle ear bones. An
intact eardrum is necessary for normal
hearing. The eardrum also protects the
middle from contamination from the
outside world. Probably the most common
reason for a tympanoplasty is a hole in
the eardrum (perforated tympanic
membrane). These holes can be the
result of infection, trauma, or a
consequence of pressure equalization
tubes.
Patients with
perforations will often have hearing
loss, though small holes might produce
little hearing loss. Some will have
ringing sound in the ear or drainage.
The cause, size
and location of the hole are important
considerations in determining if the
hole can be closed and by which
procedure. Generally speaking there are
two surgical approaches for closing
these holes: via the ear canal or via an
incision made behind the ear. Your
doctor will talk with you about the
approach he intends to use prior to
scheduling your procedure.
At the time of
tympanoplasty, your surgeon will
evaluate the status of the middle ear
bones or ossicles. These bones are
called malleus, incus and stapes. They
form a chain bones that translates the
vibration of the eardrum to the fluid of
the inner ear. These must be connected
to one another and free to move so that
sound can be conducted into the cochlea
or inner ear. The procedure that
corrects problems with these bones is
called ossiculoplasty.
Many different
procedures and prostheses are available
to correct the myriad of problems with
the ossicles. Frequently, the exact
ossicular problem cannot be known
pre-operatively, and so an assessment
must be made at the time of
tympanoplasty. Occasionally, if the ear
is infected, ossiculoplasty is delayed
until the infection resolves and the ear
heals from tympanoplasty. A second
stage repair can be performed to repair
the ossicular defect.
The risks for
tympanoplasty are hearing loss,
dizziness, tinnitus, altered or loss of
taste on the tongue, and facial weakness
or paralysis. Any ear operation has the
risk of losing hearing. The chance for
loss of all hearing in the operated ear
is probably below 1%. A person who
loses all hearing in the ear might
experience either temporary or permanent
dizziness or tinnitus. The facial nerve
courses through the middle ear just
above the stapes to control muscles on
the same side of the face. This nerve
might be injured during any ear
operation. At the time of surgery your
surgeon might use a facial nerve monitor
to monitor the function of the facial
nerve. This devices uses electrodes
that are placed in the muscles of the
face and gives feedback to the surgeon
regarding the function of the facial
nerve. The use of facial nerve
monitoring helps to identify the facial
nerve, especially in an infected or
previously operated field, and helps to
avoid injury to the facial nerve. One
branch of the facial nerve, called the
chorda tympani, lies just underneath the
eardrum. This branch of facial nerve
carries the fibers for taste on the same
side of the tongue. These fibers carry
information for salt, sweet, sour and
bitter. Of course, we experience more
"tastes" than these four, such as the
taste of chocolate or strawberry or
meat. These "tastes" are from our sense
of smell and thus are not affected by
chorda tympani. Occasionally, this
nerve is stretched or bruised while
performing tympanoplasty. Sometimes the
nerve must be cut in order to remove
completely infection or tumors. This
stretching or cutting will result in
either the alteration or loss of taste
on the side of the tongue.
The success of
tympanoplasty with or without
ossiculoplasty depends on many different
factors. Factors such as pre-existing
infection, Eustachian tube dysfunction,
and failure of prior attempts lower the
chance for success, but might not
preclude an attempt at future
tympanoplasty. Recent improvements in
surgical techniques, instruments,
medications and prostheses have helped
to increase the chance for success.
Postoperative Care
Instructions
Tympanoplasty,
Mastoidectomy
1.
Keep all water out of
operated ear. When showering,
bathing, or washing hair, place some
Vaseline on cotton ball and insert
into ear canal. When finished
washing or bathing, remove cotton
ball and wipe ear dry.
2.
Do not blow your nose or
lift objects heavier than 10 pounds.
3.
If you need to sneeze,
keep your mouth wide open to avoid
exerting excessive pressure in the
back of the nose.
4.
Avoid strenuous
activities. You may continue most
other regular activities.
5.
Keep head elevated on 2 or
more pillows when in bed.
6.
The head dressing (if any)
can be removed the day after
surgery. You may wipe the area
around the ear with a clean, damp
cloth. Avoid excessive manipulation
of any incisions.
7.
If antibiotic eardrops
have been prescribed, place 5 drops
in the ear two times a day until
your physician directs you to stop.
8.
If there are stitches
behind the ear, clean the stitches
with hydrogen peroxide; and then
apply the antibiotic ointment to the
area twice a day until your
physician directs you to stop. If
there is surgical tape (Steri-Strips)
covering the wound, leave the tape
alone and do not use hydrogen
peroxide. Two weeks after your
surgery, the tapes can be removed by
pulling from the top of the tape
downward.
9.
Any cotton in the ear can
be replaced as needed. Bloodstained
drainage from the ear is normal
after ear surgery. Once the ear
drainage subsides, the use of the
cotton can be discontinued. Do not
remove anything else from inside the
ear canal.
10.
For ear pain, use Tylenol
as directed on the package or the
prescription medication as
prescribed. The pain is usually not
severe and will subside in a few
days.
11.
If you have been given an
oral antibiotic, take it as
prescribed until it is finished.
Call the
office for purulent drainage, severe
dizziness, fever above 101.5 F, or
facial weakness.
