Tympanoplasty
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Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.
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Tympanoplasty
- 3. • Definition – Surgery for reconstruction of tympnic membrane and/or ossicles • Classification – Wullstein (1956) – Austin and Kartush
- 4. Wullstein 1 2 3 4 5
- 5. Middle ear risk index • MERI to predict the success rate. • For accurate prediction of the results of ossiculoplasty the status of middle ear and its ossicles must be ascertained. – Austine Kartush classification – TM perforation – Cholesteatoma – Belluci classification
- 6. Austine Kartush • Group A - Malleus and stapes present • Group B - Malleus and foot plate of stapes present • Group C - Malleus absent and stapes present • Group D - Malleus and stapes suprastructure absent
- 7. Austine Kartush • Kartush added 3 more classes as a modification of this scheme in include ossicular fixity even when all three ossicles are present. • O - Intact ossicular chain • E - Ossicular head fixation • F - Stapes fixation
- 9. MERI
- 10. • Indications • What are you trying to achieve?
- 11. Indication Contracindiction – no cochlear function – TypeI-perf/ discharge/ – Neoplasm of middle conductive loss/ ear or EAC – Types II-IV-perf/ – Malignant OE significant conductive – Only hearing ear or sig loss/ part of middle ear better H Ear surgery for • Relative contra cholesteotoma/ – EU dysfunction, very CSOM/ young – TypeV-stapes – Chonic ear discharge footplate fixation – If no sig hearing improvement possible with no hx of CSOM – Pt factors-smoker etc, diabetes
- 12. • Patient assessment – History – Examination – Investigations
- 14. What is: • Belfast rule of thumb? • Glasgow benefit plot
- 15. What are these? What is a TORP? PORP?
- 18. Common situations - options • Simple perforation (1) • Austin A M+S+ (1) • Austin B M+S- (?) • Footplate fixed (3) • Austin D M-S- (4)
- 22. • What are prognostic factors? – Black SPITES – Or MER
- 23. Prognosis Risk Factor Risk Value Otorrhea (Belucci) I. Dry 0 II. Occasionally wet 1 III. Persistently wet 2 IV. Wet, cleft palate 3 Perforation Absent 0 Present 1 Cholesteatoma Absent 0 Present 1
- 24. Ossicular status (Austin/Kartush) O: M+I+S+ (intact ossicular chain) 0 A: M+S+ (malleus present, stapes present) 1 B: M+S- (malleus present, stapes absent) 2 C: M-S+ (malleus absent, stapes present) 3 D: M-S- (malleus absent, stapes absent) 4 E: Ossicle head fixation 2 F: Stapes fixation 3
- 25. Middle ear - Granulations or effusion No 0 Yes 1 Previous surgery None 0 Staged 1 Revision 2
- 26. Prognosis/Risk MER Index Best prognosis (normal ear) 0 Mild risk 2 Moderate risk 5 Severe risk 7 Worst prognosis (end stage) 12
- 27. • Postoperative care • Results • Complications
Editor's Notes
- Tympanoplasty is classified into five different types, originally described by Wullstein in 1956.[1] Type 1 involves repair of the tympanic membrane alone, when the middle ear is normal. A type 1 tympanoplasty is synonymous to myringoplasty. Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in the middle ear ossicles. Type 3 involves removal of ossicles and epitypmanum when there are large defects of the malleus and incus. The tympanic membrane is repaired and directly connected to the head of the stapes. Type 4 describes a repair when the stapes foot plate is movable, but the crura are missing. The resulting middle ear will only consist of the eustachian tube and hypotympanum. Type 5 is a repair involving a fixed stapes footplate
- Perf = 1, M+S+?I = 1/0, Belluci = 0,
- Tos3, Sade ¾ M+S+ I-
- Sade4 M+S+ I-