Overview

Tympanoplasty is a surgical procedure to repair the tympanic membrane and reconstruct the middle ear for hearing restoration.

Tympanoplasty is crucial for treating chronic otitis media, tympanic membrane perforations, and restoring hearing function.

Learn more in our comprehensive RxDx ENT Course

Indications

✓
Tympanic Membrane Perforation

Chronic perforation

✓
Chronic Otitis Media

Non-suppurative

✓
Hearing Loss

Conductive hearing loss

✓
Cholesteatoma

With tympanic membrane defect

✓
Trauma

Tympanic membrane trauma

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Active infection
✗ Severe coagulopathy

Relative Contraindications

✗ Recent surgery
✗ Poor Eustachian tube function
✗ Age extremes

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, imaging review, graft selection, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Preparation

Position patient, administer anesthesia.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Inadequate anesthesia

💡 Pro Tip:

Use proper positioning.

Step 2: Graft Harvest

Harvest graft material.

⚠️ Common Mistakes to Avoid:

  • Inadequate graft
  • Donor site complications

💡 Pro Tip:

Use proper technique.

Step 3: Tympanomeatal Flap

Elevate tympanomeatal flap.

⚠️ Common Mistakes to Avoid:

  • Flap tear
  • Poor exposure

💡 Pro Tip:

Use gentle technique.

Step 4: Middle Ear Exploration

Explore middle ear cavity.

⚠️ Common Mistakes to Avoid:

  • Missed pathology
  • Ossicular damage

💡 Pro Tip:

Systematic exploration.

Step 5: Graft Placement

Place graft under tympanic membrane.

⚠️ Common Mistakes to Avoid:

  • Poor placement
  • Graft failure

💡 Pro Tip:

Ensure proper placement.

Step 6: Closure

Close incision and pack ear canal.

⚠️ Common Mistakes to Avoid:

  • Poor closure
  • Inadequate packing

💡 Pro Tip:

Use proper technique.

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Post-procedure Care

Post-procedure care involves graft protection, hearing evaluation, and long-term follow-up.

Complications & Management

Complication Incidence Signs Management Prevention
Graft failure 5-15% Persistent perforation Revision surgery Proper technique
Hearing loss 1-3% Worsened hearing Hearing aids, revision Careful technique
Infection 2-5% Otitis externa, otorrhea Antibiotics Sterile technique
Tinnitus 1-2% Ringing in ear Reassurance, therapy Gentle technique

Clinical Pearls

💡

Use proper microscope positioning.

🎯

Ensure adequate graft size.

⚡

Place graft under tympanic membrane.

🔍

Explore middle ear thoroughly.

📊

Document procedure details.

🎨

Provide clear post-op instructions.

⚠️

Monitor for complications.