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.

Tympanoplasty in Singapore

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.

Cost Comparison

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.

Causes of Hearing Loss

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

Symptoms of Hole in Eardrum

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

Types of Tympanoplasty

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, a tissue is taken. A gelatin sponge is positioned under the drum, which is absorbable and it supports the graft. Underneath the remaining drum remnant, the graft is inserted and folded back to close the perforation. The incision is closed with the help of stitches. On the outside of the ear canal, a sterile patch is placed and the patient can then be transferred to the recovery room.

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 silastic sheet is often placed to prevent the regrowth of a new bone against the wall.  In such a reconstruction, it may be required that the stapes and incus are separated from the natural connection to stop the transmission of drill vibration. This can damage the inner ear.

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.

Frequently Asked Questions

Singapore is generally known for its well-managed health care infrastructure and has an efficient and widespread system of healthcare. Singapore was ranked 6th in the World Health Organization's ranking of the world's health systems in the year 2000. Bloomberg ranked Singapore's healthcare system the most efficient in the world in 2014. Three main healthcare groups exist in Singapore:
  • National Healthcare Group
  • National University Health System
  • SingHealth
The 10 public hospitals in Singapore comprise 8 general hospitals (AH, SGH, NUH, CGH, TTSH, KTPH, NTFGH & SKH), and 2 specialized hospitals (KKH & IMH). In addition, there are 9 national specialty centres for cancer (NCCS & NCIS), cardiac (NHCS & NUHCS), eye (SNEC), skin (NSC), neuroscience (NNI) and dental care (NDCS & NUCOHS). The private healthcare infrastructure in Singapore is also well established. The payment methods include private payment gateways or private insurance companies. You can expect better technology to be used in private hospitals in Singapore. Various procedures like stem cell therapy and cancer research are conducted in Singapore.
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are some of the JCI certified hospitals in Singapore :
  • Mount Elizabeth Hospital
  • Singapore National Eye Centre
  • National Dental Centre
  • Raffles Hospital
  • National University Hospital
  • Gleneagles Hospital
  • Singapore General Hospital
  • National Heart Centre Singapore
  • Changi General Hospital
  • National Cancer Centre
  • National Skin Centre
  • Johns Hopkins Singapore International Medical Centre
  • Tan Tock Seng Hospital
Since Singapore is known all over the world for some of the best medical treatments all across the globe, you can surely expect the best quality of doctors and surgeons here. This country has a very high quality of life and hence the health of people is of high priority.
People who wish to go to Singapore as a tourist for social purposes or seeking medical treatment, and require a longer period of stay beyond the Visit Pass granted on entry into Singapore, may submit an application for extension of stay (not more than 89 days from date of entry) online using the e-Service of ICA. All extension applications must be submitted online using the e-service at least seven days prior to the expiry of the visit pass to avoid overstaying. Extension of visit will not be accepted over the counter. Every visit pass issued to any person as a tourist or for the purpose of a social visit or medical treatment shall be subjected to the condition that the holder shall not engage in any form of employment (paid or unpaid) or in any business, profession or occupation in Singapore during the validity of that pass unless he is a holder of a valid work pass issued under the Employment of Foreign Manpower Act. Do visit the ICA website for further information.
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