Type of Surgery
Information
Last updated: 02/17/2009
There are five basic types of tympanoplasty procedures:
- Type I tympanoplasty is called myringoplasty, and only involves the restoration of the perforated eardrum by grafting.
- Type II tympanoplasty is used for tympanic membrane perforations...
with erosion of the malleus. It involves grafting onto the incus or the remains of the malleus. - Type III tympanoplasty is indicated for destruction of two ossicles, with the stapes still intact and mobile. It involves placing a graft onto the stapes, and providing protection for the assembly.
- Type IV tympanoplasty is used for ossicular destruction, which includes all or part of the stapes arch. It involves placing a graft onto or around a mobile stapes footplate.
- Type V tympanoplasty is used when the footplate of the stapes is fixed.
Depending on its type, tympanoplasty can be performed under local or general anesthesia. In small perforations of the eardrum, Type I tympanoplasty can be easily performed under local anesthesia with intravenous sedation. An incision is made into the ear canal and the remaining eardrum is elevated away from the bony ear canal, and lifted forward. The surgeon uses an operating microscope to enlarge the view of the ear structures. If the perforation is very large or the hole is far forward and away from the view of the surgeon, it may be necessary to perform an incision behind the ear. This elevates the entire outer ear forward, providing access to the perforation. Once the hole is fully exposed, the perforated remnant is rotated forward, and the bones of hearing are inspected. If scar tissue is present, it is removed either with micro hooks or laser.
Tissue is then taken either from the back of the ear, the tragus (small cartilaginous lobe of skin in front the ear), or from a vein. The tissues are thinned and dried. An absorbable gelatin sponge is placed under the eardrum to support the graft. The graft is then inserted underneath the remaining eardrum remnant, which is folded back onto the perforation to provide closure. Very thin sheeting is usually placed against the top of the graft to prevent it from sliding out of the ear when the patient sneezes.
If it was opened from behind, the ear is then stitched together. Usually, the stitches are buried in the skin and do not have to be removed later. A sterile patch is placed on the outside of the ear canal and the patient returns to the recovery room.
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Other Information
Tympanoplasty is reconstructive surgery for the tympanic membrane, or eardrum. There are several options for treating a perforated eardrum. If the perforation is from recent trauma, many ENTs will elect to watch and see if it heals on its own. After that, surgery may be considered. Tympanoplasty can be performed through the ear canal or through an incision behind the ear. The surgeon takes a graft from the tissues under the skin around the ear and uses it to reconstruct the eardrum. One of the most common graft sites is from the tragus. The surgery takes ½ to 1 hour if done through the ear canal and 2⅓ to 3 hours if an incision is needed. It is done under local or general anesthesia. It is done on an outpatient basis and is successful 85-90% of the time.
Other Information
In 2006, estimates of the direct medical costs of allergic rhinitis in the US ranged from $1.16 billion to $4.5 billion, rising to $7.7 billion when indirect costs were included.
From: AHRQ
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