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What is it?
Tympanoplasty is the surgical operation that is performed to reconstruct the eardrum or the small bones of the middle ear. The goal of this surgical procedure is to close the perforation and also to improve hearing.

When is it needed?
The doctor might opt for Tympanoplasty for the following cases,

  • Presence of ear drainage that is clear, pus-filled or bloody
  • Hearing loss
  • Ringing in the ear
  • A spinning sensation from vertigo
  • Nausea or vomiting resulting from vertigo

Diagnosis
The examining doctor usually performs a complete physical examination along with diagnostic testing of the ear, which includes,

  • Audiogram: is an audiometry exam to test the hearing function of the ear. It is used to test the intensity and the tone of sounds, balance issues and other issues related to the inner ear function.
  • Evaluating the history of the hearing loss, also for vertigo or any other facial weakness.
  • Otoscopy: is usually done to inspect the mobility of the tympanic membrane and the malleus or the hammer-shaped small bone in the middle ear.
  • Fistula Test: is usually performed if the patient has a history of dizziness or the presence of a marginal perforation of the eardrum.
  • Routine blood tests
  • Routine urine examination

Procedure
Tympanoplasty is usually performed with the patient under general anaesthesia. Then the surgeon will place an instrument called ear speculum in the external ear canal. The operating microscope is then positioned.

The surgeon will then make an incision into the ear canal, usually made behind the ear for large perforations. The ear is then moved forward, carefully exposing the eardrum. The surgeon will lift the eardrum so that the middle ear can be examined.

If there is a hole in the eardrum, it is debrided and the abnormal area can be cut away. A piece of fascia, which is the tissue present under the skin, from the temporalis muscle, found behind the ear, is then cut and placed under the hole in the eardrum to create a new intact eardrum. This tissue, which is called a graft, allows the normal eardrum skin to grow across the hole. Sometimes, the surgeon might perform the reconstruction of the middle ear bones at this time.

Post-Procedure
The patient can return home within a couple of hours. The doctors might prescribe antibiotics and a mild pain reliever.

After 10 days, the packing is removed and the ear is checked to see if the graft was successful. As the graft must be free of infection to heal completely, antibiotics might be prescribed. If there are allergies or a cold, antibiotics and a decongestant are also prescribed.

After a month, all the packing is completely removed under the operating microscope. It is then determined whether the graft has fully taken.

The doctor might suggest the following preventive measures to minimize pressure that can potentially dislodge the graft.

  • Avoid water from the ear
  • Avoid nose blowing
  • Avoid using a straw to drink
  • Avoid sneezing with a shut mouth

A complete hearing test is performed four to six weeks after the surgery.

Risk Factors
There might be a few risk factors in rare cases.

  • Excessive bleeding
  • Facial nerve damage with a change in sense of taste
  • Hear loss due to damage to the small bones in the middle ear
  • Infection
  • Bleeding
  • Breathing problems
  • Reactions to medicines
  • Dizziness or vertigo
  • Chances of the hole in the eardrum not healing completely
  • Worsening of hearing or a complete loss of hearing

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