Definition: Tympanoplasty is a surgery to eradicate disease in the middle ear cleft and to re-construct the hearing mechanism with or without mastoid surgery with or without tympanic membrane grafting. Classification of Tympanoplasty:
  1. Type I: Defect in the tympanic membrane is repaired by a graft after checking the mobility and status of the ossicular chain. It is also called Myringoplasty.
  2. Type II: There is perforation of tympanic membrane with erosion of malleus or part of incus. 
    • Type II a: Graft is kept touching the malleus remnant, incus or Incudo-stapedial joint.
    • Type II b: Here the incus is also diseased. The body of the incus is refashioned to fit into the stapes head. The short process of incus goes under the handle of malleus.
  3. Type III: Malleus and Incus are absent.
    • Type III a: Low facial ridge: Graft is kept below the level of malleus touching the stapes head, called Myringostapediopexy.
    • Type III b: High facial ridge: Graft not directly touching the stapes head but below the level of malleus.
  4. Type IV: Only the footplate of stapes is present, exposed to the external ear, and graft is placed in between oval and round windows. A narrow middle ear, cavum minor, is made to have an air pocket around the round window. Sound waves act directly on the footplate while round window has been shielded.
  5. Type V: Stapes footplate is fixed but round window is functioning. Here another window is created on lateral semicircular canal and covered with a graft. It is also called fenestration operation.
  6. Type VI: Sono-Inversion: All sound waves enter through the round window keeping the oval window covered (reverse direction).
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Most common grafts used in Tympanoplasty
  • Temporalis fascia- most common.
  • Cartilage.
  • Perichondrium.
  • Fascia Lata.
Incision approach for tympanoplasty
  • Endaural approach.
  • Postaural approach.
  • Endomeatal (Transcanal) approach.
Specialist ENT Screenshot 2020 11 20 Ear final book document
Anesthesia for Tympanoplasty
  • Usually done in Local anesthesia.
  • General anesthesia can used in uncooperative patients.
Techniques of placement of Graft in tympanoplasty
  • Underlay technique.
  • Overlay technique.
  • Interlay technique.
  • Double breasting technique
Specialist ENT Screenshot 2020 11 20 Ear final book document

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