Tympanoplasty

A ruptured eardrum can affect the ability of hearing and may be caused by several reasons such as: 

• Otitis Media- infection of the middle ear due to accumulation of fluids
• Barotrauma- differences in air pressure in the middle ear and outside causing extreme stress on the ear drum
• Blast or exposure to very loud sound
• Puncture by a sharp object
• Severe head injury 

Symptoms

A tympanoplasty is recommended for an eardrum perforation, which may occur due to the following reasons:

• Otitis media (middle ear infection)
• Acoustic trauma (loud sounds)
• Barotrauma (trauma to the ear due to the sudden fluctuations in the air pressure level around the ears due to automobile accidents, scuba diving, etc.)
• Severe head injury or trauma
• Insertion of certain foreign objects in the ear, like a hairpin, cotton swab, etc.

Symptoms:
The following symptoms may indicate eardrum damage and may require tympanoplasty surgery:

1. Pain in the ear 
2. Bleeding from the ear
3. Ringing sound in the ear
4. Fluid leakage from the ear
5. Discharge from the ear 
6. Vertigo
7. Nausea
8. Vomiting

Diagnosis

1. Physical examination: The doctor will evaluate the physical health of the patient. The symptoms and medical history of the patient are evaluated.
2. Lab examination: Any discharge from the ear needs to be examined in a laboratory to find out the possible cause of infection.
3. Tuning fork evaluation: Hearing loss that occurs due to damage to the vibrating parts of the middle ear (the eardrum and bones) or damage to the ear nerves can be diagnosed using a tuning fork.
4. Audiology exam: This type of examination includes a series of tests performed to evaluate hearing at different pitches and volumes in a soundproof booth in order to diagnose loss of hearing.
5. Tympanometry: A device is inserted into the ear to check for any air pressure changes in the ear and diagnose a perforated eardrum.

Treatment

The procedure is generally performed under general anesthesia, that is, the patient is put to sleep during the procedure.

The procedure may be performed using any one of the following techniques:

1. Postauricular tympanoplasty: A curved incision is made behind the auricle (the crease in the outer ear).
2. Endaural tympanoplasty: An incision is made above the ear canal.
3. Transcanal tympanoplasty: The doctor reaches the middle ear through the ear canal in this technique. This procedure is performed of the eardrum hole is small and located in the back of the eardrum.
4. Laser-assisted tympanoplasty: This procedure does not require an incision and it involves the use of infrared lasers, like CO2 laser, to precisely cut the tissues near the hole to repair the ear drum. This CO2 laser is absorbed by the tympanic membrane and it does not damage the middle ear. This type of procedure has a better prognosis than the other techniques used.

• The doctor then removes the excess scar tissue using a micro hook or laser that has built up in the middle ear to get complete access to the eardrum tear. 
• A graft is then taken obtained from an ear lobe, the skin behind the ear or synthetic graft is used to fill the hole.
• The graft is used to repair the hole and ensure that the eardrum functions properly.
• The incision will then be closed using sutures (stitches).
• It takes approximately half an hour to two hours to complete the surgery.

Risks

The complications associated with tympanoplasty include:

1. Infection

2. Bleeding

3. Failure to treat hearing loss

4. Dizziness 

5. Tinnitus (ringing sound in the ears)

6. Drainage of fluid or blood from the ear

7. Bad taste in the mouth

8. Failure of the graft

After Procedure

1. It is normal to have some bleeding and drainage for the first three to five days after tympanoplasty.
2. It is normal to have symptoms like shooting pain, a feeling like some liquid has been filled in the ear, and clicking or popping sounds in the ear after tympanoplasty. These symptoms are usually temporary and go away on their own in a few days.
3. The doctor will recommend using ear drops that need to be used by removing the ear packing and then replacing the packing after the ear drop application is completed.
4. The stitches will usually be removed one week after surgery.
5. You can resume going to work within one to two weeks of tympanoplasty surgery.
6. Complete recovery following tympanoplasty may take about two to three months.
7. You will be given ear packs after surgery. The cotton needs to be changed regularly. The ear packs will stay in the ward for five to seven days following tympanoplasty.

Home remedies:

The following tips will enable you to have a smooth and quick recovery after tympanoplasty:

1. Clean the region near the site of surgery using a dry cotton ball.
2. Avoid any water from entering your ear.
3. Elevate your head by using pillows while sleeping to reduce swelling.
4. Avoid strenuous activities, contact sports, and heavy lifting for two to three weeks after surgery.
5. Avoid flying or swimming without getting approval for the same from your doctor.
6. Wear a shower cap while taking a bath to prevent water from entering the ear.
7. Avoid blowing your nose or popping your ears.
8. If you feel like sneezing, do so with an open mouth so that there is no buildup of pressure in the ears.
9. Avoid going to crowded places or going near people who are sick, as it may increase your possibility of catching an infection.

Cost of tympanoplasty in India- 

The cost of tympanoplasty in Mumbai is between INR 40,000 to INR 70,000.
The cost of tympanoplasty in Delhi is between INR 35,000 to INR 65,000.
The cost of tympanoplasty in Bangalore is between INR 35,000 to INR 65,000.
The cost of tympanoplasty in Chennai is between INR 30,000 to INR 60,000.