Otitis Media and Its Surgery (Tympanoplasty)

Tympanoplasty can be performed through incisions through the ear canal, in the ear, or behind the ear. Surgery can be performed through the ear canal without an additional incision to repair only a small hole in the tympanic membrane. For holes in the middle or posterior part of the tympanic membrane, an incision is made on the inside of the ear, while for holes in the anterior part of the tympanic membrane and in cases where surgery on the mastoid bone is required, an incision is made behind the ear. The most important factor in this regard is the preference of the surgeon who will perform the operation.

The tissue most commonly used to repair the tympanic membrane is the temporal fascia. Because this tissue is close to the surgical site, it can be easily obtained during surgery. The cartilaginous membrane in front of the ear canal or prefabricated materials (materials such as sterile cerebral cortex pieces that have undergone appropriate procedures) can also be used. In recent years, repair with thin strips of cartilage obtained from the cartilage in front of the ear canal (cartilage tympanoplasty) has become increasingly popular, especially for large holes, both because of the ease of use and the success of the results.

If due to damage to the ossicles, repair is needed to ensure sound transmission, many different materials can be used such as prostheses made of different materials, parts made of the cartilage in front of the ear canal, and the middle ear ossicles by positioning and shaping.

Patients can usually be discharged from the hospital with bandages on the first day after surgery.

Special sponges put during the surgery in the external ear canal are cleaned after 10-14 days in surgeries without mastoid bone intervention, and it is recommended that patients protect their ears from water and use antibiotic- and cortisone-containing ear drops to prevent infections and reactions in the surgical area. Recovery in this group is complete in 3-4 weeks. In general, during the first month, it is necessary to protect oneself from flu-like infections and avoid hits and airplane travels. In these patients, the technical and functional success rate of the surgery is generally quite good, depending on the extent of the pathology and the preoperative hearing level.

On the other hand, in patients who underwent mastoid bone operation during surgery, different bandages should be applied for different periods of time depending on the type of surgery performed. Healing takes longer in this group, and hearing gain is generally less in these patients than in the other group.

Especially when the cholesteatoma is near the facial nerve and inner ear, the bone in these areas cannot be scraped off to avoid damaging the nerve and hearing, and the disease may persist at the cellular level.

Because the risk of recurrence of cholesteatoma is high in these patients, follow-up examinations should be performed at regular intervals after surgery. In this group of patients, interventions to restore the sound transmission system can be performed if the cholesteatoma recurs in small foci or at the second follow-up surgery performed 6-12 months later.

Consequently, there is no standard approach to tympanoplasty surgery that is appropriate for every patient. In the selection of surgical techniques and applications used during surgery, especially in cases with cholesteatoma, the characteristics of the disease and the patient, the factors identified, and the experience of the surgeon are effective.