Tympanoplasty (Eardrum Surgery)? What Are the Causes, Symptoms and Treatment Methods?
Thanks to positive developments in healthcare technology, tympanoplasty (eardrum surgery) is frequently used today to repair damage to the eardrum. Eardrum surgery is performed to repair holes or tears in the eardrum, also known as the tympanic membrane. The eardrum plays a critical role in hearing. When it is damaged for any reason, hearing loss may occur. Eardrum surgery is a procedure that can be performed using endoscopic/microsurgical (closed) techniques, without the need for a skin incision. So, what is eardrum surgery and how is it done? In which cases is eardrum surgery preferred? Questions such as these about eardrum surgery are discussed in detail in the following sections of this article.
What Is Tympanoplasty (Eardrum Repair)?
The eardrum is one of the important structures that transmits sound waves from the outside to the hearing center. If the eardrum is damaged, problems such as hearing loss may occur. The eardrum can be damaged by causes such as infection and trauma. When the eardrum is damaged for various reasons, it needs to be repaired to prevent permanent hearing problems. One of the commonly used treatment procedures for repairing the eardrum is eardrum surgery, known in the medical literature as tympanoplasty (1).
Tympanoplasty is an operation performed to repair a perforated eardrum or to eliminate infection in the middle ear. A tympanoplasty operation can be performed solely to repair the eardrum, or also to repair the chain of middle ear bones (the malleus, incus and stapes). Tympanoplasty is a minimally invasive operation performed in cases of eardrum perforation or damage for any reason, especially in patients with chronic middle ear infection. The main situations in which eardrum surgery is performed can be listed as follows (1):
Chronic middle ear infection,
Tearing of the eardrum by an object such as a cotton swab,
Ear tube surgery, usually performed to drain fluid accumulated in the middle ear,
Ear trauma
What Are the Symptoms of a Middle Ear Infection?
Looking at the anatomy of the ear, it consists of three main parts: the outer ear, the middle ear and the inner ear. The outer ear consists of the auricle (pinna) and the ear canal; the middle ear consists of the malleus, incus and stapes bones and the eustachian tube, which connects the middle ear to the throat; and the inner ear consists of the cochlea and semicircular canals. Sound coming from outside passes through the auricle to the ear canal and then reaches the eardrum. Sound waves reaching the eardrum cause it to vibrate. The vibrating eardrum transfers the sound waves to the incus, malleus and stapes bones, which play an important role in hearing (2).
If any of the structures in the ear is affected, sound cannot be transmitted clearly to the hearing center in the brain. When it comes to ear, nose and throat diseases, one of the first that comes to mind is middle ear infection. As with other tissues and organs in the body, infectious diseases caused by microorganisms such as viruses and bacteria can also occur in the ear. Middle ear infection, known in the medical literature as otitis media, occurs in the middle ear, which lies behind the eardrum. According to research, middle ear infection is seen in approximately 80% of children before school age (3). The symptoms of middle ear infection vary depending on the severity of the infection. The main symptoms seen in middle ear infection can be listed as follows (4, 5):
Discharge from the ear,
High fever,
Loss of balance,
Pain in and around the ear,
Irritability,
Difficulty sleeping,
Nausea and vomiting,
Diarrhea,
Feeling of fullness in the ear,
Difficulty hearing
The severity of the symptoms listed above may vary depending on factors such as the cause of the infection, the person's age and general health.
What Are the Causes of a Middle Ear Infection?
The main causes of middle ear infection include microorganisms such as viruses and bacteria. Acute middle ear infection usually develops as a result of upper respiratory tract infections such as the flu and the common cold. Bacteria or viruses in the upper respiratory tract can spread to the middle ear through the eustachian tube. This may cause inflammation in the middle ear. In addition, bacteria or viruses affecting the upper respiratory tract can cause the eustachian tube to swell. The swollen eustachian tube can cause fluid normally produced in the ear to accumulate in the middle ear instead of draining. One of the reasons children are more likely than adults to develop middle ear infections is this blockage. Children's eustachian tubes are shorter and more horizontal than those of adults. This may cause the eustachian tube to become blocked more easily and make children more susceptible to middle ear infection (5). Middle ear infection has three main types: acute, serous and chronic. The causes of middle ear infection vary depending on whether the disease is acute or chronic. The main known causes of acute and chronic middle ear infection can be listed as follows (5, 6):
Acute middle ear infection: A sudden-onset ear infection that usually occurs together with a common cold or another upper respiratory tract infection. Bacteria or viruses affecting the respiratory tract can cause fluid to build up behind the eardrum and lead to infection. Acute ear infections can appear suddenly, and symptoms may improve within a few days.
Serous middle ear infection: Serous middle ear infection usually occurs as a continuation of an acute infection. In serous middle ear infection, symptoms such as pain and fever are not seen; however, ear discharge is more common due to fluid accumulation in the eustachian tube.
Chronic middle ear infection: A condition in which ear discharge continues for more than 3 months despite treatment. An ear infection experienced in childhood and/or a serous middle ear infection that persists for a long time may lead to the infection becoming chronic. Although acute middle ear infection varies from person to person, it usually resolves within 6 weeks. In chronic middle ear infection, this period is longer. In addition, an untreated, chronic middle ear infection may eventually cause damage to the eardrum and hearing loss (6).
Acute and serous middle ear infections usually heal on their own within a few days or weeks. However, an untreated middle ear infection may cause damage to the eardrum and hearing loss in the long run. Therefore, if you suspect a middle ear infection, do not neglect to make an appointment with a specialist doctor and have the necessary examinations.
How Is a Middle Ear Infection Diagnosed?
Patients who present to clinics with complaints of middle ear infection are first examined in detail by a specialist ear, nose and throat doctor. During the examination, the doctor first takes the patient's medical history. The patient is then examined using a special instrument called an otoscope. In addition, if the specialist doctor deems it necessary, other tests may be used to evaluate the patient's hearing function (6). If you notice symptoms such as ear discharge, ear pain or decreased hearing, do not neglect to make an appointment with a specialist doctor without delay.
How Is a Middle Ear Infection Treated?
Treatment of middle ear infection varies depending on factors such as the patient's age, the type of infection, its severity and its duration. In treatment, specialist doctors may first prescribe medications with pain-relieving/fever-reducing properties to relieve symptoms. In addition, if the doctor believes the source of the infection is bacteria, antibiotics may also be used. In some cases, fluid in the middle ear may persist for a long time. In such cases, doctors may recommend inserting an ear tube in the patient. An ear tube is a small tube inserted through a small incision made in the eardrum. These tubes allow air to enter the middle ear, helping the fluid drain out. Ear tubes are generally used more often in children with frequently recurring infections or hearing loss.
In addition, in some cases, a middle ear infection that persists for a long time may cause damage to the eardrum or, as the inflammation progresses, damage the small bones in the ear. In situations like these, specialist doctors may recommend tympanoplasty, i.e., eardrum surgery.
How Is Middle Ear Infection Surgery Performed?
Middle ear infection surgery is a procedure that can be performed using endoscopic/microsurgical methods (closed) without the need for a skin incision. Tympanoplasty is a surgical method aimed at repairing a damaged eardrum and preventing recurrence of the infection, whether or not there is ossicular damage (7). Details about tympanoplasty are discussed below.
Preparation Before Surgery
Before eardrum surgery, the patient's ear and hearing function are examined in detail. First, the patient's head and neck area is examined and their general health is assessed. The specialist doctor uses an otoscope to carefully examine the condition of the middle ear and whether there is a tear in the eardrum, or any discharge or infection in the ear. If the specialist doctor deems it necessary, the patient's hearing loss is evaluated with an audiometry test (1).
How Is the Surgery Performed?
Eardrum surgery can be performed using different techniques. In patients who have only a hole in the eardrum without any signs of infection or discharge, the eardrum can be repaired by endoscopic entry through the ear canal. However, in cases such as inflammation, discharge or damage to the small bones in the middle ear, the operation is performed through a small incision behind or in front of the ear, using the patient's own tissue, usually taken from the temporal region (temple area). If there is a problem with the small bones that enable hearing, bone repair may also be performed during surgery using prostheses made of different materials, through methods such as stapes surgery and ossiculoplasty (1, 7).
Post-Surgery Process
After eardrum surgery, patients may return home on the same day. In some cases, the surgeon may ask the patient to stay in hospital overnight (1 night). Recovery time after surgery varies between 10 days and 2 weeks depending on the person's general health. Mild bleeding from the ear during this period is considered normal. However, if the bleeding is severe, it is important to consult a doctor without delay. After surgery, if possible, care should be taken not to blow the nose forcefully for at least 3 weeks. In addition, it is important to avoid washing the hair for several days after the operation to prevent water from entering the ear (1).
Frequently Asked Questions About Eardrum Surgery
Eardrum surgery is a treatment method frequently applied to patients whose eardrum has been damaged or who have chronic middle ear infection. Some of the frequently asked questions about eardrum surgery are detailed below.
An untreated middle ear infection and eardrum perforation may lead to permanent hearing loss in the long term. If you are experiencing symptoms such as ear pain, discharge or difficulty hearing, do not neglect to make an appointment with a specialist doctor without delay and have your check-ups done.
The eardrum transmits sound waves from the outside to the hearing center in the brain through vibration. An untreated eardrum perforation/tear may lead to permanent hearing loss in the long term. Endoscopic eardrum surgery is the procedure of repairing the tear by entering the ear canal with the help of an endoscope, without making any incision in front of or behind the ear. If the eardrum is damaged, symptoms such as pain, discharge and hearing loss may occur. Eardrum surgery is used in cases of chronic infection in the middle ear and/or a tear in the eardrum. The duration of the operation is approximately 2-3 hours, depending on the procedures performed during surgery. After surgery, on the advice of the specialist doctor, it is important to avoid taking showers for several days and to avoid any activity that could cause water to enter the ear. In addition, it is recommended to avoid movements that may create pressure in the ear, such as blowing the nose, for at least 3 weeks.
