Anatomy & Physiology

The anatomy of the middle ear cleft is extremely important in combined approach tympanoplasty. It relies on an accurate knowledge of the relationship between the facial nerve in its vertical portion and the chorda tympani. Indeed it is the bony triangle between them that is drilled in order to open up the channel between the mesotympanum and mastoid regions. It is referred to as the posterior tympanotomy. In all other respects the anatomy of the middle ear cleft is as for any other operation.

Indications

Indications for a combined approach tympanoplasty are as follows:

  • Serous otitis media- rarely
  • Stage III/IV retraction pockets (Sade classification)
  • Chronic suppurative otitis media (granulations/cholesteatoma)
  • Placement of middle ear hearing aid
  • Placement of cochlear implant

Procedure

Tympanoplasty is an operation to repair a hole in the ear drum. Mastoidectomy is an operation to remove disease or infected bone behind the ear. It is sometimes combined with repair of an ear drum. Both of these surgeries are done under general anesthetic and are done on an outpatient basis. Following surgery there should be minimal pain and the ear canal will be packed with gel foam in order to support the graft which dissolves with in 2 weeks. You may or may not have a scar. If you do it will be behind the ear and will not visible.

Time off work

Seven to Ten days.
Risks and Complications

Risks include total hearing loss, dizziness, noises, facial paralysis, loss of taste of the tongue, secondary infection and recurrence of disease. There is also the need for a second look procedure with or without conversion to a cavity if necessary.