It has been that all ages irrespectively get affected with ear disorders and hearing impairment problems. In Unites states a survey result revealed that under the age of 65 over 60 of the population of the nation is suffering with hearing loss problems. However almost 25 of those more than the age of 65 having loss of hearing problems is taken to be significant. And for all such people and depending upon the intensity of the problem ear surgery is recommended of various types.
The surgeon or the examining physician shall conduct a proper diagnosis and testing of the ear. The process will include an audiogram and history of the loss in hearing. It shall also evaluate facial weakness or vertigo experienced. A microscopic examination is performed and otoscopy is used to understand the mobility of malleus and tympanic membrane. A fistula test is also performed if history of marginal perforation and dizziness is found.
Apart from this entire blood and urine test is conducted prior to surgery.
With intravenous sedation and local anesthesia this surgery can be performed. 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 whole 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 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 tissue is taken. They are then then thinned and dried. A gelatin sponge is positioned under drum which is absorbable and that supports the draft. Underneath the remaining drum remnant the graft is inserted and folded back making for the closure.
Against the top of the graft in order to stop sliding out the ear if the patient ever sneezes, a silastic thin sheet is placed. Outside to this sheet gel foam is placed holding it in position in a sandwich type layer.
Now when opened from behind the ear it will be stitched together. These stitches are buried under the skin and do not require removal later. On the outside of the ear canal a sterile patch is placed and the patient can then return to recovery room.
In case an ossicular reconstruction is required then it is recommended for an overnight stay.
If the bones in the ears suffer erosion then ossicular reconstruction is advised. At times it can be determined before surgery but in many other cases it can be visible only when the ear is completely opened under the microscope.
The reconstruction can happen at the time of the ear drum construction and possible if it is not infected and dry. 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 mentioned above is small. But if the gap is large then the anvil bone is removed and remodeled to give a shape like a tooth making use of the operating microscope. After reshaping the prosthesis it is placed between the malleus and the stapes and ossicular chain continuity is then reestablished.
In some other ossicular construction the malleus can get fixated by bony ingrowth or scar tissue to the ear’s lateral wall. In this case the bone has to be separated from the wall of the canal and undergo remodeling.
Plastic type or silastic sheeting is very often placed to prevent the regrowth of a new bone against the wall. In such reconstruction it may be required that the stapes and incus are separated from the natural connection in order to stop the drill vibrations’ transmission. This can damage the inner ear.
Usually a patient of tympanoplasty is discharged within two to three hours of the surgery. Along with a mild pain reliever some antibiotics are 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 and prevent blowing of nose. If the patient is suffering from cold and allergies then decongestant are prescribed. Within 5 to 6 days the patients can resume to normal life. After 3 weeks total packing is removed under the operating microscope, and now 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. Tympanic pressure changing activities will be asked to avoid like using a straw to drink or blowing of the nose and finally a hearing test is performed after 4 to 6 weeks.
Tympanoplasty advantages and complications
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