Surgery of the Tympanic Membrane, Middle Ear and Mastoid
Tympanoplasty, also called eardrum repair, refers to surgical procedures performed to reconstruct a perforated tympanic membrane (ear drum). Sometimes it includes reconstruction of the small bones (ossicles) in the middle ear.
The tympanic membrane of the ear is a three-layer structure. The outer and inner layers consist of epithelium cells. Perforations occur as a result of defects in the middle layer, which contains elastic collagen fibers. Small perforations usually heal spontaneously.
However, if the defect is relatively large, or if there is a poor blood supply or an infection during the healing process, spontaneous repair may be hindered. Eardrums may also be perforated as a result of trauma, such as an object in the ear, a slap on the ear, or an explosion.
The purpose of tympanoplasty is to repair the perforated eardrum, and sometimes the middle ossicles that consist of the incus, malleus, and stapes. Tympanic membrane grafting may be required. If needed, grafts are usually taken from a vein or fascia (muscle sheath) tissue on the lobe of the ear.Synthetic materials may be used if patients have had previous surgeries and have limited graft availability.
Stapedectomy is a surgical procedure in which the innermost bone (stapes) of the three bones (ossicles) of the middle ear is removed, and replaced with a small plastic tube surrounding a short length of stainless steel or titanium wire (a prosthesis). A stapedectomy is performed to improve the movement of sound to the inner ear.
It is done to treat progressive hearing loss caused by otosclerosis, a condition in which spongy bone hardens around the base of the stapes. This condition fixes the stapes to the opening of the inner ear, so that the stapes no longer vibrates properly. Otosclerosis can also affect the malleus, the incus, and the bone that surrounds the inner ear.
As a result, the transmission of sound to the inner ear is disrupted. Untreated otosclerosis eventually results in total deafness, usually in both ears.
A mastoidectomy is a surgical procedure that removes an infected portion of the mastoid bone when medical treatment is not effective. A mastoidectomy is performed to remove infected mastoid air cells resulting from ear infections, such as mastoiditis or chronic otitis, or by inflammatory disease of the middle ear (cholesteatoma).
The mastoid air cells are open spaces containing air that are located throughout the mastoid bone, the prominent bone located behind the ear that projects from the temporal bone of the skull. The air cells are connected to a cavity in the upper part of the bone, which is in turn connected to the middle ear. Aggressive infections in the middle ear can thus sometimes spread through the mastoid bone.
When antibiotics cannot t clear this infection, it may be necessary to remove the infected area by surgery. The primary goal of the surgery is to completely remove infection so as to produce an infection-free ear. If you are having difficulty hearing or an infected ear, the first step towards better hearing is to schedule an evaluation with an experienced ear, nose and throat doctor.
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