Tympanoplasty or ear reconstruction surgery is a process that is done to terminate the tear in the eardrum. The surgery is performed only on the eardrum and not on the ear bones. After an examination of the eardrum which is ruptured the doctor asks you to keep patience for a maximum period of 6 weeks. The surgery is only performed after it is found out that your eardrum did not heal. A ruptured eardrum is very common among children. Though the surgery is a safe one still a patient might face bleeding and infection in the year. Apart from this, a patient can stop hearing or hear partially because of a ruptured eardrum even though he underwent surgery. You can face breathing issues.
If you are undergoing Tympanoplasty surgery in Singapore then the surgeon informs you not to consume anything 8 to 10 hours before the surgery. An expertized ENT surgeon performs the general anesthesia on you before proceeding with the surgery. The entire surgery will take up to 3 hours. First of all, the surgeon uses a microscope to take a closer look at your eardrum through the ear canal. If he finds that your ear canal is very tiny then he makes a slit at the back of your ear. An underlay or an overlay method can be used by your surgeon to perform the surgery. In the underlying method, the graft is kept so that it broadens under the hole. While in the overlay method the graft is placed on the outside covering of the tympanic membrane. The graft is packed using a special sheet so that the graft stays in place.
Tympanoplasty surgery cost in Singapore is $ 4,600 but the prices may vary from time to time.
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People from all age groups can get affected by ear disorders and hearing impairment problems. In the United States, a survey revealed that under the age of 65, over 60 per cent of the population suffers from problems related to hearing loss. However, almost 25 per cent of people aged above 65 experience a significant loss of hearing. Thankfully, different types of ENT surgeries are available to treat problems related to the ear.
Most often, people are diagnosed with problems related to the eardrum, or tympanum, and the infection in the cells of the mastoid bone. The tympanum is the thin membranous structure present between the outer and the middle ear. It vibrates when sound waves hit on it and this enables us to hear.
A repair surgery called tympanoplasty is required to treat a perforation or hole in the eardrum. The middle ear is sterile but due to rupture of the eardrum, an infection can also occur. It may also be required for repairing of tiny bones present behind the eardrum or ossicles in the mastoid bone. This repair is known as mastoidectomy.
Tympanoplasty and mastoidectomy are therefore conducted together in many cases. This procedure is known as tympano-mastoidectomy.
There are several reasons that may cause loss of hearing, including the following:
Birth defect
An ear infection that has grown very severe and left untreated for long
The injury suffered by the ear
Ear subjected to excessive levels of noise
Hearing loss as a result of age
Other reasons
Some of the common symptoms of a puncture in eardrum include the following:
Sharp pain in the ear that disappears abruptly
Excessive pressure, which will suddenly disappear with the rupture and pus formation in the ear
Loss of hearing
Dizziness
Type 1 tympanoplasty or myringoplasty is the surgery that ensures restoration of the eardrum that got perforated with drafting
Type II tympanoplasty addresses membrane perforations with erosion in the bone malleus. Grafting is done on the incus bone or in the remains of the malleus.
Type III tympanoplasty is meant for destruction of two ossicles and intact and mobile stapes bone. A graft is placed on the stapes and it provides protection for the total assembly.
Type IV tympanoplasty is useful for cases of ossicular destruction, which has all or part of the arch of stapes included. A graft is placed around the mobile stapes footplate
Type V tympanoplasty is useful when the footplate of the stapes bone is fixed.
For treating Cholesteatoma, tympanoplasty can be combined with stapedectomy and mastoidectomy and in many cases, a second operation is required to ensure the infection is totally eradicated.
The tympanoplasty surgery is performed with intravenous sedation and local anaesthesia. An incision is made into the ear canal section and from the bony ear canal, the remaining eardrum is elevated and lifted forward. Under the operating microscope, the ear structures can be seen clearly. An incision behind the ear is made if the hole is very large or far forward. It ensures that the entire outer ear is forwarded, giving better access to the perforation.
The perforated remnant part is rotated forward after the hole is exposed and now the ossicles are inspected. Scar tissue and bands can surround the bones and they are removed with a laser or micro hooks. Now the ossicular chain is pressed to check its mobility and functionality. If it is found to be mobile, then the rest of the surgery aims at repairing the defect of the drum.
From the tragus, which is the cartilaginous lobe of skin in front of the ear, or from the back of the ear,
If the bones in the ear suffer from erosion, then ossicular reconstruction is advised. At times it can be determined before surgery but in other cases, erosion is visible only when the ear is completely opened under the microscope. The reconstruction can happen at the time of the eardrum construction. Bone erosion can happen at the tip of the incus or anvil. A discontinuity between stapes and the incus has to be resolved.
A small piece of bone or cartilage can be inserted from some other part of the body of the patient if the gap between the two cones mentioned above is small. But if the gap is large, then the anvil bone is removed and remodelled to give a shape of a tooth with the help of the operating microscope. After reshaping the prosthesis, it is placed between the malleus and the stapes and ossicular chain continuity is then re-established.
In some other ossicular construction, the malleus can get fixated by bony ingrowth or scar tissue to the ear’s lateral wall. The plastic-type or
Usually, a patient is discharged within two to three hours of the surgery. Along with a mild pain reliever, some antibiotics are also administered. After 10 days, the patient is again expected to visit so that packing can be removed and graft success can be checked.
Patients are advised to keep water away from the surgical site and avoid blowing of the nose. If the patient is suffering from cold and allergies, then decongestants are prescribed. Within 5 to 6 days, the patients can resume a normal life. After 3 weeks of the surgery, the packing is removed under the operating microscope and at this point, the grafting success can be completely determined.
Care must be taken by the patient to soak the ear canal with antibiotics to keep infection at bay. Shearing forces of excessive tension should not be felt by the graft. The surgeon will advise the patient to avoid activities that alter the tympanic pressure, including using a straw to drink or blowing of the nose. Finally, a hearing test is performed after 4 to 6 weeks of the surgery.
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