From the Research
Yes, a dry tympanic membrane perforation with moderate to severe conductive hearing loss (CHL) and preserved ossicles on CT scan is typically an indication for tympanoplasty, and possibly ossiculoplasty depending on intraoperative findings. Tympanoplasty would repair the perforated eardrum using a graft (typically temporalis fascia or cartilage), while the preserved ossicular chain suggests that extensive ossicular reconstruction may not be necessary. However, despite normal appearance on CT, there may still be ossicular discontinuity or fixation causing the conductive hearing loss that can only be definitively assessed during surgery 1. The surgeon would evaluate the ossicular chain intraoperatively and perform ossiculoplasty if needed to restore sound transmission. This approach addresses both the anatomical defect (perforation) and functional deficit (hearing loss). The dry status of the perforation is favorable for surgical success, as active infection would increase the risk of graft failure.
Key Considerations
- The size and location of the tympanic membrane perforation can affect the degree of conductive hearing loss, with larger perforations and those in the posterior quadrant potentially leading to greater hearing loss 2, 3.
- Ossicular chain status is directly associated with the severity of conductive hearing loss when the tympanic membrane is intact, and ossicular chain disruption or fixation can impact surgical outcomes 1.
- Postoperatively, patients typically require 4-6 weeks of water precautions and activity restrictions to allow proper healing of the graft.
Surgical Approach
- Tympanoplasty would be performed to repair the perforated eardrum using a graft (typically temporalis fascia or cartilage).
- Ossiculoplasty may be necessary if intraoperative findings indicate ossicular discontinuity or fixation causing the conductive hearing loss.
- The surgeon would evaluate the ossicular chain intraoperatively and perform ossiculoplasty if needed to restore sound transmission.
Outcomes
- Studies have shown that ossiculoplasty surgery under oto-endoscope has good efficacy in improving hearing outcomes in patients with conductive hearing loss and intact tympanic membrane 4.
- Long-term complications after ossiculoplasty are a significant consideration, and risk factors such as tobacco smoking, Eustachian tube dysfunction, and poor hearing result on the first postoperative audiogram can impact outcomes 5.