Procedure for Mastoidectomy, Ossiciloplasty, Endoscopic Tympanoplasty

What is Endoscopic Tympanoplasty?

Endoscopic tympanoplasty is the procedure to repair the perforated eardrum using an endoscope instead of a microscope. The three small bones of the middle ear namely, the ossicles the malleus, incus, and stapes can also be involved in the procedure.

Causes of Eardrum Perforation

The following are the causes of eardrum perforation:

• Injury/trauma
• Acute and chronic infections
• Tumors
• Excessive noise pollution
• Birth defect
• Old age

The Tympanic Membrane

Small perforations heal on their own but bigger perforations involving a large area along with infection causes improper healing and in such cases a surgical repair (tympanoplasty) needs to be performed. At times, tympanic membrane grafting is done. Grafts are usually obtained from:

• Veins
• Fascia
• Synthetic material

Tympanoplasty Procedure

The different types of tympanoplasty procedures are:

• Type I Tympanoplasty

  - the restoration of the perforated eardrum by grafting.

• Type II Tympanoplasty

  - the restoration of the tympanic membrane perforations with erosion of the malleus.

• Type III Tympanoplasty

  – when tympanic membrane is perforated along with destruction of two ossicles, with the stapes still intact and mobile.

• Type IV Tympanoplasty

  – when ossicular destruction involves the three bones.

• Type V Tympanoplasty

  – if the footplate of the stapes is fixed.

Tympanoplasty, depending on the severity of damage is done under local or general anesthesia. In small perforations of the tympanic membrane, surgery is performed under local anesthesia with intravenous sedative.

Pre Surgery Care

Patient needs to undertake certain tests and procedures before proceeding for surgery. They are:

• History of the hearing loss
• History of vertigo
• Complete ear testing of the ear
• X- Ray
• An audiogram
• Otoscopy
• Facial weakness/paralysis
• Blood and urine tests

Advantages of Endoscopic Surgery

The following are the advantages of endoscopic surgery:

• The procedure has 90% success rate
• Better surgical view
• Minimum invasive surgery and small incision size
• Lesser chance of injury
• Shorter duration of surgery
• Better visualization of middle ear cavity
• Less post-surgical pain and complications

Disadvantages

The following are the disadvantages of Endoscopic surgery:

• Less efficient when only one-hand surgery is done
• If massive bleeding occurs the view from the endoscope is stained by blood and procedure becomes difficult to pursue
• Direct injury can be caused by the endoscope
• Thermal damage by the endoscopic light can be caused

Some Statistical Data

Hearing loss affects across ages. It increases with age.

Causes of hearing loss:

• Genetic 4%
• Ear injury 8%
• High decibels sound 37%
• Ear infection 18%
• Old age 32 %

How Long Hospital Stay is Required During This Surgery?

The patient has to be admitted 1 day before the surgery. It is a short duration surgery of about 2 -3 hours. The patient may be discharged the same day.

Indications

The procedure is indicated in:

• Injury/trauma
• Acute and chronic infections
• Tumours both benign and malignant
• Excessive noise pollution
• Birth defect
• Old age
• Any age is safe

Contraindications

It is contraindicated in:

• Active infections
• Active bleeding
• Any uncontrolled chronic illness such as diabetes.

Risks/Complications

Immediate and delayed complications are as follows:

• Graft failure
• Recurrent perforations
• Narrowing of the ear canal
• Scarring/adhesions in the middle ear
• Fistula formation
• Hearing loss
• Erosion of prosthesis
• Dislocation of the prosthesis
• Facial nerve injury
• Tinnitus and continuous echo type noises

Post-Operative Care

The patient can expect the following:

• Patient is discharged post 3 to 4 hours post surgery
• Antibiotics/ear drops are prescribed for about a week
• Pain killers are given
• Ear packing is removed after 10 days and the graft is evaluated
• Ear should be kept dry
• Do not blow nose
• Hearing test is done