Name of the Procedure:

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (e.g., postfenestration)

Summary

Tympanoplasty with ossicular chain reconstruction is a surgical procedure designed to repair the eardrum and the tiny bones within the middle ear that are responsible for hearing. The procedure corrects damage, improves hearing, and resolves chronic ear infections.

Purpose

Medical Condition:

• Chronic ear infections, perforated eardrum, damaged ossicles ##### Goals/Outcomes:
• Restoration of hearing, elimination of infections, and repair of the eardrum and ossicular chain.

Indications

• Persistent ear infections not responsive to medication.
• Hearing loss due to damage to the eardrum or ossicular chain.
• Perforated eardrum that has not healed on its own.
• Previous ear surgery that needs revision.

Preparation

• Fasting for 6-8 hours before surgery.
• Arranging transportation and time off work for recovery.
• Diagnostic tests: hearing tests (audiometry), imaging (CT scan).
• Medications: Stopping blood thinners and certain medications as advised by the doctor.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Canalplasty: The ear canal is widened if necessary to allow better access.
3. Atticotomy and Middle Ear Surgery: The surgeon accesses the middle ear and inspects the ossicles.
4. Ossicular Chain Reconstruction: Damaged ossicles are repaired or replaced with prosthetic devices.
5. Tympanoplasty: The eardrum is repaired using a graft taken from the patient’s own tissue (often from the tragus or temporalis fascia).
6. Closure: Incisions are closed, and a sterile dressing is applied.

Duration

Typically takes 2 to 3 hours.

Setting

Performed in a hospital or surgical center.

Personnel

• ENT surgeon (Otolaryngologist)
• Anesthesiologist
• Surgical nurses

Risks and Complications

• Common Risks: Temporary dizziness, tinnitus, minor bleeding.
• Rare Risks: Infection, continued hearing loss, facial nerve injury, taste disturbances.
• Management of Complications: Follow-up appointments, medications, and potential additional procedures.

Benefits

• Improved hearing
• Resolution of chronic ear infections
• Enhanced quality of life ##### Realization of Benefits:
• Hearing improvement is often noticed within a few weeks post-surgery.

Recovery

• Post-Procedure Care: Keeping the ear dry, taking prescribed medications, and attending follow-up visits.
• Restrictions: Avoid strenuous activities and air travel for a few weeks.
• Recovery Time: Approximately 2-4 weeks for initial recovery, with full benefits realized in a few months.

Alternatives

• Hearing aids: Non-surgical option for hearing improvement.
• Myringoplasty: Less extensive surgery for eardrum repair without ossicular reconstruction. ##### Pros and Cons:
• Hearing aids are non-invasive but do not address infections.
• Myringoplasty is less complex but may not improve hearing as significantly if ossicles are damaged.

Patient Experience

• During the Procedure: Patients are under general anesthesia and will not feel pain.
• After the Procedure: Some discomfort managed by prescribed pain medication.
• Pain Management: Over-the-counter pain relievers and prescribed medications as needed.
• Comfort Measures: Elevating the head, avoiding sudden movements, and using ear protection against noise and water.