TYMPANOSPLASTY

 

Tympanoplasty is a surgical procedure used to repair a perforated tympanic membrane (eardrum) or to reconstruct the middle ear's hearing bones (ossicles). The primary goal of tympanoplasty is to improve hearing and prevent recurrent ear infections. There are several types of tympanoplasty, depending on the extent and location of the damage to the ear, and the specific techniques used can vary.

​

Here's a brief overview of the procedure and its types:

1. Types of Tympanoplasty:

   • Type I (Myringoplasty): Involves the repair of the tympanic membrane alone without touching the ossicles.

   • Type II: Involves grafting onto the ossicles in addition to the tympanic membrane.

   • Type III: The ossicular chain is rebuilt, and the graft is placed on the stapes (one of the ossicles).

   • Type IV: A graft is placed on a mobile stapes footplate, and the rest of the ossicular chain is absent.

   • Type V: Involves fenestration of the horizontal semicircular canal.

2. Procedure:

   • The procedure is often performed under general anesthesia.

   • A surgeon will typically access the eardrum through the ear canal or via an incision behind the ear.

   • Damaged parts are either removed or repaired, and a graft (often taken from the patient's own tissue) is used to patch the eardrum.

3. Indications for Surgery:

   • Chronic ear infections that don't respond to other treatments.

   • Perforated eardrum, often from chronic infections or trauma.

   • Hearing loss due to damage in the middle ear.

                                                                                                 

​

                                                        Anesthetic Implications for Tympanoplasty

​

Anesthesia type: General, local anesthesia

​

Airway: ETT or LMA

​​

Preoperative:

​​

• Patients are generally young and healthy

• The function of the middle ear is to transmit sound from the environment to the inner ear

• The tympanic cavity is connected to the nasopharynx via the Eustachian tubes, which aerate the middle ear and equalize its pressure with that of the atmosphere

• Check with the surgeon before giving muscle relaxants (facial nerve monitoring)

• Need to identify and preserve the facial nerve

• The 7th cranial nerve goes through the temporal bone and originates in the brainstem

• EMG-based neural monitor is used to assess neural function

​​

Intraoperative:

​

• Do NOT administer nitrous oxide (change in air pressure in risks dislodgement of the graft)

• Facial nerve monitoring may be done 

• Position: supine

• Controlled hypotension may be used to minimize blood loss and maintain clear surgical field

​

Postoperative:

​

• Smooth emergence to prevent prosthesis displacement

• PONV prophylaxis

• Pain management

​​

Complications:

​

• Bleeding

• Hematoma formation

• Facial nerve injury

• Suture line disruption

• Vascular injury

• Venous air embolism

• Transgression of the dura

• Spinal fluid leak

• PONV

​

​

Sources:

​

Elisha, S. (2010). Case Studies in Nurse Anesthesia.

​

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

​

Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

​

Pairaudeau C, Mendonca C. Anaesthesia for major middle ear surgery. BJA Educ. 2019 May;19(5):136-143. doi: 10.1016/j.bjae.2019.01.006. Epub 2019 Mar 6. PMID: 33456882; PMCID: PMC7808081.

​

Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

​

​

​

​

 

​​

​​