Tympanoplasty and Mastoidectomy

Tympanoplasty

Tympanoplasty is the repair of the eardrum and/or middle ear bones. Tympanoplasty is most commonly performed for repair of the eardrum. Eardrum perforations (holes) are usually caused by trauma or infection. Two methods are commonly done to repair the eardrum.
The first is a Myringoplasty which is used to repair a small hole in the eardrum. In this operation, the hole’s margin is rimmed, a process which removes skin and tissue, and a small piece of fat is placed into the hole. This operation does not take a long time and in adults can be performed in an office setting under local anesthesia.

The second operation is a formal Tympaoplasty. In this operation, the middle ear is entered through a canal skin flap and a piece of muscle tendon or fascia is placed beneath the perforation. This operation is usually performed in the operating room and takes much longer under a general anesthesia.

Mastoidectomy

Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics.
Purpose
Mastoidectomy is performed to remove infected air cells within the mastoid bone caused by mastoiditis, ear infection, or an inflammatory disease of the middle ear (cholesteatoma). The cells are open spaces containing air that are located throughout the mastoid bone. They are connected to a cavity in the upper part of the bone, which is in turn connected to the middle ear. As a result, infections in the middle ear can sometimes spread through the mastoid bone. When antibiotics cannot clear this infection, it may be necessary to remove the infected air cells by surgery. Mastoidectomies are also performed sometimes to repair paralyzed facial nerves.
Description
Mastoidectomy is performed less often today because of the widespread use of antibiotics to treat ear infections.
There are several different types of mastoidectomy:
• Simple (or closed). The operation is performed through the ear or through a cut (incision) behind the ear. The surgeon opens the mastoid bone and removes the infected air cells. The eardrum is cut (incised) to drain the middle ear. Topical antibiotics are then placed in the ear.
• Radical mastoidectomy. The eardrum and most middle ear structures are removed, but the innermost small bone (the stapes) is left behind so that a hearing aid can be used later to offset the hearing loss.
• Modified radical mastoidectomy. The eardrum and the middle ear structures are saved, which allows for better hearing than is possible after a radical operation.
The wound is then stitched up around a drainage tube, which is removed a day or two later. The procedure usually takes between two and three hours.
Aftercare
Painkillers are usually needed for the first day or two after the operation. The patient should drink fluids freely. After the stitches are removed, the bulky mastoid dressing can be replaced with a smaller dressing if the ear is still draining. The patient is given antibiotics for several days.
The patient should tell the doctor if any of the following symptoms occur:
• Bright red blood on the dressing.
• Stiff neck or disorientation. These may be signs of meningitis.
• Facial paralysis, drooping mouth, or problems swallowing.
Risks
Complications do not often occur, but they may include:
• Persistent ear drainage.
• Infections, including meningitis or brain abscesses.
• Hearing loss.
• Facial nerve injury. This is a rare complication.
• Temporary dizziness.
• Temporary loss of taste on the side of the tongue.
Cholesteatoma
A rare but chronic inflammatory disease in which skin cells and debris collect in the middle ear, usually as a result of an ear infection.
Mastoiditis
An inflammation of the bone behind the ear (the mastoid bone) caused by an infection spreading from the middle ear to the cavity in the mastoid bone.

Dr Paulose is an ENT Consultant Plastic and Laser Surgeon with over 32 years of experience covering in Ear, Nose and Throat procedures, specializing in Laser Surgery and conventional medicine across India, U.K. and Middle East. He is currently engaged with the SUT Hospital, in Kerala, India. You can contact him today for help.