Tympanoplasty in Tunisia

Treatment and Cost

10

Total Days
In Country

2 No. Travelers

2 Day in Hospital

8 Days Outside Hospital

Treatment Price not available

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About the Tympanoplasty

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.

How is Tympanoplasty performed?

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.

Recovery from Tympanoplasty

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.

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Tunisia / Why should opt for Tunisia as a destination for your medical treatment?
Hospitals in Tunisia are developing and trying to meet the international standards of healthcare. Although there is a basic set up in most of the hospitals for treatment in Tunisia, one can still expect scope for improvement. The Ministry of Health, along with the Government of Tunisia is making effective changes for the healthcare sector. The private hospitals in Tunisia are also undergoing a robust change to provide effective healthcare and treatment in Tunisia.

Like most other countries, hospitals in Tunisia have a private and public healthcare system. Hospitals in Tunisia include three levels of care: primary, with a network of 81 clinics and 2091 basic health centers; secondary, with 109 district hospitals; and tertiary, with 33 regional hospitals and 24 modern CHUs, according to MoS figures.
What are the conditions of the hospitals in Tunisia? Are they JCI certified? What is the quality of the support staff in the hospitals?
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.
In Tunisia, there are no JCI accredited hospitals but 4 private hospitals are certified ISO and OHSAS (Occupational Health and Safety Assessment Series).
Are the doctors/surgeons in Tunisia of the best quality?
The hospitals in Tunisia have seen a constant change in terms of development and technology. Most doctors that are trained in the country understand the needs and requirements of people and are able to diagnose and treat them well. There are various surgeons that fly in from other countries as well to treat patients. This was brought about due to the economic reforms and various expats residing there. The varying levels of health organizations provide reasonable means of treatment for any patient. There are also trained paramedical and emergency service staff in this country.
What is the process for obtaining a medical visa in Tunisia?
Patients who wish to visit Tunisia for medical purposes must contact the Embassy of Tunisia in their home country. One is required to have a valid passport. Those applicants must submit their visa application forms in person together with the following documents:
  1. A duly completed application form with one picture (within a white background).
  2. Original biometric passport and one copy. Passports should have a validity of at least one year from the date of your visa application submission.
  3. Medical certificate stating the type of illness and the treatment to be carried out. This document has to be in English or Spanish language.
  4. Letter from the hospital in Tunisia stating the appointment date and whether the treatment expenses have been already paid in full.
  5. Proof of financial means which enable the applicant to meet life needs while in Tunisia (salary certificate if working, bank statement for the last six months, property deeds, commercial license, other sorts of income).
  6. Travel insurance.
  7. Proof of accommodation (hotel reservation, etc)
  8. Applicants are advised that ALL PASSPORTS HAVE TO REMAIN at the Embassy premises while the visa application is under process (between 10 and 15 days), and therefore cannot be retrieved unless very special and urgent circumstances might arise.
  9. The Embassy has the right to require from the applicant any document that it may deem relevant in order to resolve the visa file.
What support services does MediGence provide in Tunisia?
MediGence enables you to plan and manage your medical decisions better. These are some of our services offered:
  • Expert Opinion
    We help you seek an Expert Opinion on your diagnosis and treatment from an experienced team of doctors at MediGence and specialists from a reputable hospital.
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    A dedicated patient case manager stays in constant touch with you to help you at every step of the decision-making process and resolve queries that you may have.
  • Transparent Treatment Cost and Other Expenses
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  • Visa Assistance
    We provide and help prepare documentation for visa approval and coordinate with the embassy to expedite the visa process.
  • Accommodation Arrangements
    We propose to you a choice of accommodation based on your preference such as long stay, short stay, or luxury properties.
Which are the best cities in Tunisia for medical treatment?
Tunis is the largest country and capital of Tunisia. This country is located in the northern region of Africa and is the best city for treatment in Tunisia.

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