Tympanoplasty

The tympanoplasty ( Greek tympanon , "cymbal"; tympanum of the ear; Plastic : surgical repair) is an operation of the ear, in the ear drum ( tympanic membrane , Myrinx ) or the ossicular chain , or both, to be repaired or restored.

Tympanoplasty is required in the case of permanent perforation of the eardrum or in the case of defects in the ossicular chain, primarily due to injury, inflammation or cholesteatoma .

Perforated eardrum, membrana tympani . One sees under 1) a tympanosclerosis 2) the hammer handle, manubrium mallei 3) the stapes head, stapes

History of tympanoplasty

With Joseph Toynbee (1815–1866) the scientifically founded otology began , by creating a solid basis through his investigations into the pathological anatomy of the ear. Emil Berthold (1837–1906) tried for the first time surgically to cover an eardrum defect. He called the procedure myringoplasty. Berthold used a piece of skin tissue that had been explanted from the upper arm , which he pressed evenly onto the edge of the eardrum with the wound surface after appropriate pretreatment, so that the perforation site was evenly covered. The outer ear canal was then carefully filled with cotton wool without moving the graft. Later, after experiments with different materials, Berthold used the outer egg skin (outer shell skin) of a hen's egg ; the results varied widely. Rudolf Haug, a Munich resident, found out that it was crucial which side of the egg membrane was placed on the eardrum defect.

There are some slightly different classifications of tympanoplasty according to the extent of the reconstruction, which originally go back to Horst Ludwig Wullstein . A distinction is made according to a common classification:

Eardrum perforation before and after tympanoplasty

• Myringoplasty : Restoration of the eardrum alone .
• Type I : Restoration of the eardrum and restorative measures in the middle ear with an intact ossicular chain.
• Type II : Restoration of the ossicular chain (and possibly the eardrum) with an intact stapes .
• Type III : Restoration of the ossicular chain (and possibly the eardrum) in the case of a defective stapes.
• Type IV : Covering the round window for sound insulation (sound protection).

surgery

The procedure is performed under local or general anesthesia. It is operated either through the ear canal after a small incision in the ear canal entrance or after an incision behind the ear. The operation is carried out under the surgical microscope. Sometimes a bony constriction of the auditory canal has to be drilled open with a diamond drill or removed with a so-called spoon so that the eardrum is fully visible. If there is no otosclerosis, i.e. the stapes can move normally and are intact, there is often a defect in the long process of the incus. The anvil is then removed and its body positioned between the stapes and the long hammer handle. An interrupted ossicular chain can also be reconstructed with prostheses made of metal, ceramic or plastic. If the eardrum has a hole, it is closed with the body's own muscle or cartilage skin ( perichondrium ) or with a cartilage disk. At the end of the operation, the incision is sutured and the ear canal is tamponized for 3 weeks.

Possible complications and risks

Usually short-term wound pain; slight and harmless secondary bleeding; persistent ear runny ears; temporary or persistent ringing in the ears ( tinnitus ); temporary or persistent dizziness ( vertigo ); usually only temporary taste disturbances when the chorda tympani was stretched or had to be cut; lack of hearing improvement; rarely increase in hearing loss up to numbness; another hole in the eardrum; Recurrence of suppuration from the middle ear; cosmetically disturbing scars or keloid ; cicatricial constriction of the ear canal; Inflammation of the cartilage of the auricle; rarely facial nerve palsy ( facial nerve palsy ).

See also

• Radical cave

literature

• Georg Theissing, Jürgen Theissing, Gerhard Rettinger, Jochen A. Werner: ENT surgery theory: with all important interventions . 4th edition. Thieme, Stuttgart a. a. 2006, ISBN 3-13-463704-9 ( limited preview in Google Book Search).
• Rudolf Haug: About the organizational ability of the shell skin of the hen's egg and its use in transplants: an experimental surgical-histological study. Rieger, Munich 1889.

Individual evidence

1. ↑ Esther Schimanski: History of the tympanoplasty . 2004 ( ub.ruhr-uni-bochum.de [PDF] dissertation, Ruhr University Bochum).
2. ↑ Emil Berthold: About myringoplasty . In: Med.-Chir. Centralbl. tape 14 , 1879, p. 195-207 .
3. ↑ Vincent Van Rompaey, Matthew RB Farr, Evert Hamans, Albert Mudry, Paul H. Van de Heyning: Allograft Tympanoplasty: A Historical Perspective . In: Otology & Neurotology . tape 34 , 2013, p. 180-188 , doi : 10.1097 / MAO.0b013e31826bf16d , PMID 23032665 .
4. ↑ Monthly for Ear Medicine, Volume 24, Expedition of the General. Medicinischen Central -leitung, 1890, p. 217
5. ↑ Wolf Lübbers: hearing improvement on time. The artificial eardrum . (PDF) In: ENT-Nachrichten , 2, 2011
6. ^ Mirko Tos: Manual of Middle Ear Surgery . tape 1 . Thieme, Stuttgart 1993, ISBN 3-13-112701-5 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !