Tympanoplasty - Science topic
Tympanoplasty is a surgical reconstruction of the hearing mechanism of the middle ear, with restoration of the drum membrane to protect the round window from sound pressure, and establishment of ossicular continuity between the tympanic membrane and the oval window. (Dorland, 28th ed.)
Questions related to Tympanoplasty
How long do you keep the mastoid dressing in case of post auricular incision.? Also in mastoidectomy cases when do u remove it?
When do you start ear drops ?
Do you ask your patients to perform valsalva ? When ?
Do you remove the gelfoam or allow it to resolve naturally ?
When do you repeat the audiogram?
Sometimes the radical mastoidectomies take much longer to heal. Even with ciprofloxacin, antifungal drops and aspiration and debriding oozing persists. When is culture and skin grafting warranted?
Tympanoplasty is very commonly done. But how many resorts to the Eustachian tube Function tests before that
I have read few articles on endoscopic middle ear surgery. I have tried this in some cases and find it interesting except that one hand is not free. Please share your experiences
At our place we use fat in a bath plug fashion with fascia late over it and then tissue glue on that.
Also my doubt is regarding placement of the fascia lata should we place the muscle side of the graft towards the defect we are sealing or vice versa and why?
And What side of fascia lata do we keep towards the freshened margin of the perforation in tympanoplasty?
We say that the perforation in mucosal COM becomes permanent when the edge of the perforation gets covered by the epithelial layer, which prevents the healing.
Hence we freshen the margins during tympanoplasty. But is it always so ? Do we always have to freshen the edges ?
Many times in tympanoplasty we place the graft on the handle of malleus and under the annulus after denuding the malleus. But some amount of epithelium stays back at the umbo which is difficult to remove.
Will all such cases lead to iatrogenic middle ear cholesteatomas? How many of such patients actually present with symptoms requiring surgical exploration ?
Normally epithelial migration is from the centre to the periphery . We denuded the handle of malleus during tympanoplasty . How does the epithelial growth occur over the underlay graft we place??
I had a case of 40 yr female posted for revision tympanoplasty . She was operated using temporal fascia graft which had medialized, during the revision surgery I found that her handle of malleus was fractured, foreshortened too. She otherwise had an intact ossicular chain. How would you manage such a case ?