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:
  1. Overlay Technique:Graft in placed lateral to the Annulus.
  2. 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.
  1. Perichondrium from the tragus
  2. Tragal cartilage
  3. Vein
TYPES OF TYMPANOPLASTY
Wullstein's classification
  • Type I ; Myringoplasty (for TM perforation)
  • Type II : for TM perforation + erosion of malleus
  • Type III : Myringostapediopexy/Columella tympanoplasty
  1. Malleus and incus absent
  2. Graft placed over stapes head (columella effect)
  • Type IV : Only foot plate of stapes present
  1. Graft placed between oval window and round window
  2. Foot plate exteriorized over which sound waves act directly (baffle effect)
  • Type V : Fenestration operation
  • Type VI : Sono Inversion
  • ? 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.

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