Tympanoplasty

TYMPANOPLASTY 

• Tympanoplasty is the surgical operation performed for reconstruction of tympanic membrane and/or middle ear ossicles.
• Tympanoplasty is mainly done in mostly in cases of CSOM.
• Myringoplasty is the reconstruction of tympanic membrane.
• Ossiculoplasty is the reconstruction of ossicular chain.
• Tympanoplasty = Myringoplasty ± ossiculoplasty.

MYRINGOPLASTY

Two types of Myringoplasty:

• Overlay Technique:Graft in placed lateral to the Annulus.
• Underlay Technique:Graft is placed medial to the Annulus.

Graft used for Myringoplasty:

• Temporalis fascia (most common).
• Temporalis fascia is the commonly used graft material because:
• It is an autograft with excellent chance of take
• It is available close to the site of operation making its harvest easier
• It has a low basal metabolic rate, brightening its success rate
• Its thickness is more or less similar to that of tympanic membrane.

Perichondrium from the tragus

1. Tragal cartilage
2. Vein

TYPES OF TYMPANOPLASTY

Wullstein’s classification 

1. Type I ; Myringoplasty (for TM perforation)
2. Type II : for TM perforation + erosion of malleus
3. Type III : Myringostapedopexy/Columella tympanoplasty

• Malleus and incus absent
• Graft placed over stapes head (columella effect)

Type IV : Only foot plate of stapes presentGraft placed between oval window and round window

• Foot plate exteriorized over which sound waves act directly (baffle effect)

1. Type V : Fenestration operation
2. Type VI : Sonoinversion

?    Best graft for myringoplasty — temporal fascia

Exam Question

• Myringoplasty is plastic repair of Tympanic membrane.
• Myringoplasty is generally done using Temporalis Fascia or Perichondrium.
• In Myringoplasty,underlay graft is placed medial to the annulus.
• Columella effect is seen in Tympanoplasty.
• Tympanoplasty is mainly done in mostly in cases of CSOM.
• Tympanoplasty is eradication of middle ear disease with reconstruction of tympanic membrane & ossicles.