A tympanoplasty is a surgery done to repair a hole in the tympanic membrane, otherwise known as the eardrum, or to reconstruct the small bones within the middle ear. A hole in the tympanic membrane may be caused by previous grommets, a burst eardrum (due to infection), eardrum injury such as puncturing or due to cholesteatoma (a growth within or behind the eardrum). While the eardrum generally heals on its own, when a perforated eardrum doesn’t, it may predispose you to chronic discharge and possible hearing loss. Thus, surgery is needed to close the hole to improve hearing as well as prevent water from getting into the middle ear and causing an infection.
This surgery may be done by your ENT surgeon under general anaesthesia using a minimally invasive approach. This may involve a microscope or endoscope with a specialised camera to allow for visualisation while performing surgery on these very small structures in the ear. A graft, either taken from behind the ear or the ear lobe, is then used to repair the hole in the tympanic membrane. Thereafter a packing material is placed on top of the eardrum to keep the graft in place. This material then dissolves in the next few weeks.
The mastoid is a bone situated behind the ear and is filled with air cells made of bone and looks like a honeycomb. It can become diseased when an ear infection spreads into the skull. A mastoidectomy is an operation done to remove diseased mastoid air cells. This surgery is generally necessary for those who have an acute infection affecting the mastoid bone, but may also be done for chronic ear infections or to remove a cholesteatoma (a growth of abnormal tissue within or behind the eardrum). Antibiotics usually treat these infections, but surgery is an option if antibiotics fail.
The mastoid bone may be accessed through a small incision behind the ear or through the ear canal. There are different types of mastoidectomies, but your ENT surgeon will choose the type based on your specific case. During a simple mastoidectomy, the mastoid bone is opened, and the infected air cells are removed with a microscope or endoscope before the middle ear is drained. A radical mastoidectomy and modified radical mastoidectomy are both reserved for complicated mastoid disease as they involve the removal of the mastoid air cells, the eardrum, some or all of the middle ear structures, and the ear canal. With both a radical mastoidectomy and a modified radical mastoidectomy, you may have some hearing loss. Dr van Lierop will see you regularly afterwards to assess your healing and recovery.
- Stapes surgery
A stapedectomy is a surgery done to treat conductive hearing loss caused by otosclerosis. Otosclerosis causes a build-up of bone around the stapes (stirrup bone) within the ear. This build-up of bone prevents the stapes from moving as they should, resulting in hearing loss. By replacing the stapes with a prosthesis, which remains in place permanently the sound can be transmitted from the eardrum to the inner ear. While not everyone with otosclerosis needs this surgery, those with severe hearing loss may benefit from stapedectomy as it restores normal hearing in more than 90% of cases.
A stapedectomy is done under general anaesthesia. During surgery, a microscope and endoscope fitted with a camera are used so that Dr van Lierop can visualise the inner ear while operating. An incision is made in the skin of the ear canal, and the eardrum is lifted to expose the stapes bone beneath it. The bone is then removed, and a prosthesis is put in place. The eardrum and skin of the ear canal are laid back in place. The ear canal is then packed for healing. You may have dizziness, ringing or buzzing in your ear for a while after surgery, but this is temporary. It may take up to 2 months for the swelling and bruising inside the ear to subside. During this time, your hearing may not seem any better, but once healed, you will notice a drastic change in how well you are hearing.