What is Tympanoplasty ?

Tympanoplasty (eardrum repair) is a surgical procedure to rebuild a perforated eardrum (tympanic membrane) or the middle ear's tiny bones. The problem of the tympanic membrane may be the outcome of severe infection or from any trauma to the eardrum. There are three layers of the tympanic membrane. Both inner and outer layers have epithelium cells. The condition of perforations can be due to defects in the middle ear that includes elastic collagen fibers. The small perforations can be easily healed but in the case of larger defect, the process of healing is hindered. The reasons for perforated eardrums could be an outcome of trauma like a slap on the ear, an explosion or any object in the ear. The aim of tympanoplasty surgery is to restore the perforated eardrum and also the middle ear bones consisting of stapes, incus and malleus.

Tympanoplasty Procedure

The surgical procedure can be performed by following the trascanal approach (ear canal) and starts by making an incision either through the ear or at the back of the ear. To rebuild the tympanic membrane, a graft is taken. The tragus and the temporalis fascia are the common graft sites. The surgery takes place under local anesthesia and takes about 2-3 hours to complete. The time taken usually depends upon the approach undertaken. The procedure is done on an inpatient basis and the success rate is as high as 80-90%.

Tympanoplasty Myringoplasty

The human ear is made up of three parts. The first part of the outer ear that gathers sound, then the middle ear is joined to the outer ear on every side of the head. Further deeper, there is also an inner ear on every side. In between the outer and middle ear, the ear drum stretches across the most deepest section of the ear tube. Children having a hole in the eardrum will result in perforation. This could be the result of-

• The trauma of the drum is caused by using the cotton swabs to clean the ears
• Repeated infections of the ear
• The earlier placement of tubes in the ear in order to drain the fluid that accumulates behind the eardrum
• The germs can also enter through the hole that can further lead to ear infection

The hearing is largely affected as the hole stops the normal vibration of the eardrum. The hearing can be improved and ear infections can be prevented by sealing up the hole. The improvement in the hearing depends upon the size of the hole.

Ear Lobes

Ear lobes are basically made up of soft skin and a little amount of fatty tissue. The tear of earlobe tissues is often caused either by trauma or by excessive weight. For hiding the unattractive appearance of the torn earlobe, clip-on earrings may be fitted. There are various reasons for which earlobe repair surgery is required -

• Congenital ear lobe defect
• Accident
• Wearing heavy earrings can cause the hole in the earlobe to split or enlarge
• Pulling earrings in a harsh way ( entanglement of earring and earring snatching attempt)
• Stretched earlobe either by wearing heavy earring or by any other reason
• Piercing of the ear where in a number of cases come with damaged keloid and earlobes
• Some diseases
• Sports mishap like wrestling

Ear Lobe Surgery

The surgery can be done in a single session or stage by stage basis that depends largely on the damaged caused to the earlobe.

• For repairing the elongated earlobe that has been caused by wearing heavy earrings, stretched earlobe surgery is performed
• The procedure of reconstructive ear lobe surgery is performed for damaged earlobe or to correct the defect since the time of birth and also correcting the shape of the earlobe
• The torn earlobe surgery is performed to repair the earlobe tear
• For repairing the split earlobe, split ear lobe surgery is performed.

Octoplasty Surgery (Ear Pinning Surgery)

The surgical procedure is performed to correct the disfiguring injuries or deformities caused to the external ear. Often called as ear pinning or ear repairing, this surgery is mostly performed in children than in adults. The surgery can offer a more pleasing shape to the ears. The cosmetic surgery of Otoplasty is done to reduce the big size of the ears and also done to set ears closer to the head.

However, there are other problem that can be corrected by this surgery-

• The surgery is meant for those people who have lost their ears due to some injury or were born without them
• Stretched or large earlobes
• The condition of Lop Ear is developed when the tip folds down forward
• Cupped Ear (very small ear)
• The condition of Shell ear is developed when the natural creases and folds and also the curve in the outer rim are missing.
• Lobes with wrinkles and large creases

Benefits of Otoplasty

• The surgery is performed on outpatient basis
• It corrects ear abnormalities from injuries and trauma
• The procedure is simple, safe and most commonly performed
• It repositions the ear closer to the head
• It involves a short recovery period

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Hearing Loss Treatment

The treatment depends on whether the hearing loss is temporary (reversible hearing loss) or permanent. The permanent hearing loss can be treated with hearing implants and devices.

Reversible Treatment largely depends on its own causes -

• Injury to the head or ear may require surgery
• By consuming antibiotics, the middle ear infection can be cured
• Acoustic Neuroma and Otosclerosis requires surgery
• The problem of autoimmunity can be treated with the help of corticosteroid medicines.

Permanent Hearing Loss can be treated with the help of -

• Different hearing implant devices can be used for different types of hearing problems. Cochlear implant is one such implant.
• With the help of hearing implants, the sounds can be made louder. These hearing aids cannot correct the hearing problem but can help in communicating.
• Also alerting devices, communication aids and assistive listening devices can also be used.

What is Otosclerosis?

The fixation of the stapes bones happens as a result of abnormal growth in the small bones of the middle ear. The proper functioning of the ear depends on the free movement of the stapes bones. The process of hearing starts by first sending sound vibrations (from the outer ear) inside the ear canal and from there the sound vibrations hit the ear drum. The movement of the ear drum causes vibrations sends the vibrations into the three tiny bones- anvil (incus), stirrup (stapes) and hammer (Malleus). The hearing (auditory) nerve is stimulated when there is a movement of the stapes bone that sets the motion of the inner ear fluids. The sound energy is then transferred by the auditory nerve in the brain that leads in sound hearing.

Otosclerosis Symptoms

• The person will start hearing whispers or low-pitched sounds
• Balance problems
• Buzzing
• Hissing in the head or ears (tinnitus)
• Sensation of ringing
• Dizziness
• Gradual hearing loss

Treatment for Otosclerosis

Otorlaryngologist can advise the use of hearing aids to increase the sound that will reach to the ear drum, provided if the hearing loss in not serious. The specialists can also advise Sodium fluoride that can slow the development of the disease. However, the most effective surgical method is Stapedectomy that improves hearing.

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