What is Tympanoplasty?
Tympanoplasty is a surgical procedure to repair a perforated tympanic membrane (eardrum) and/or reconstruct the middle ear structures, typically performed to restore hearing and prevent recurrent infections. 1, 2
Surgical Technique and Approach
Tympanoplasty involves entering the middle ear space through elevation of a tympanomeatal flap to access and repair the damaged tympanic membrane, distinguishing it from simpler myringoplasty procedures that repair the drumhead without middle ear exposure. 3 The procedure typically uses a graft material—most commonly temporalis muscle fascia or cartilage—to reconstruct the perforated membrane. 4
Key Technical Variations
Type I tympanoplasty specifically addresses tympanic membrane perforation when the ossicular chain (middle ear bones) is intact and functional. 3
Cartilage tympanoplasty demonstrates superior structural outcomes with graft integration rates of 92.4% compared to 84.3% for temporalis fascia, and significantly lower revision rates (10% versus 19%). 2 This technique is particularly valuable for high-risk cases including total perforations, cholesteatoma, recurrent perforations, and atelectatic ears. 4
Mediolateral graft technique achieves 97% success rates for large anterior or subtotal perforations by placing the graft medially (underlay) to the posterior half and laterally (overlay) to the anterior half of the perforation. 5
Primary Indications
The procedure is indicated for:
Chronic tympanic membrane perforations that persist for ≥10 months without spontaneous healing. 1
Persistent perforations after tympanostomy tube extrusion, which occur in 1-2.6% of pediatric cases and represent the most common sequela requiring surgical intervention. 1
Cholesteatoma management with reconstruction of the tympanic membrane. 4
Conductive hearing loss from tympanic membrane perforation, where the procedure aims to close the air-bone gap. 6
Expected Outcomes
Anatomic Success
Overall success rates range from 80-90% for achieving intact tympanic membrane closure with a single outpatient procedure. 1, 7
In pediatric chronic otitis media, surgical success rates at 12-month follow-up reach 95% for perforations and 93% for cholesteatoma cases, regardless of patient age, contralateral ear status, or extent of surgery. 6
Success rates are higher for smaller perforations (<50% of tympanic membrane) at 90-91% compared to larger perforations (>50%) at 83-85%. 3
Hearing Improvement
Significant improvement in air-bone gap occurs in patients with chronic otitis media with perforation, though not typically in cholesteatoma cases. 6
More than 70% of operated ears demonstrate hearing improvement of 0-40 dB even without ossiculoplasty. 5
After successful closure, patients may experience a mild hearing threshold increase of only 1-2 dB, which is not clinically significant. 1, 7
Important Clinical Distinctions
Tympanoplasty differs fundamentally from tympanostomy tube insertion, which is a separate procedure where small ventilation tubes are placed through the eardrum to treat recurrent middle ear infections or persistent fluid. 8 Tympanostomy tubes are temporary devices that typically fall out spontaneously within 1-2 years, whereas tympanoplasty is a reconstructive procedure for permanent repair. 8
Risk Considerations
Children with prior tympanostomy tube placement have a 9.5- to 200-fold increased risk of subsequently requiring tympanoplasty compared to those without tubes or middle ear disease. 1, 7
Anesthesia-related complications occur in approximately 1 in 50,000 ambulatory surgical procedures. 8, 2
Potential tympanic membrane sequelae including tympanosclerosis or focal atrophy are generally transient or non-functional. 2
Perforation risk with cartilage grafts is only 1.0-1.4% in large series, substantially lower than the 2% rate associated with tympanostomy tubes. 2