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surgical correction or repair of defects or injuries in the eardrum or the bones of the middle ear

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/27 18:38:55」(JST)

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Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum (tympanic membrane) and/or the small bones of the middle ear (ossicles).

Classification[edit]

Tympanoplasty is classified into five different types, originally described by Horst Ludwig Wullstein (1906–1987) in 1956.^[1]^[2]

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 epitympanum 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.

Myringoplasty[edit]

The term 'myringoplasty' refers to repair of the tympanic membrane alone.^[3]

There are several options for treating a perforated eardrum. If the perforation is from recent trauma, many ear, nose and throat specialists will elect to watch and see if it heals on its own. After that, surgery may be considered.

Surgical Approach[edit]

Tympanoplasty can be performed through the ear canal (trascanal approach), through an incision in the ear (endaural approach) or through an incision behind the ear (postauricular approach).

A graft may be taken to reconstruct the tympanic membrane. Common graft sites include the temporalis fascia and the tragus.

The surgery takes ½ to 1 hour if done through the ear canal and 2⅓ to 3 hours if an incision is needed. It is done under local or general anesthesia. It is done on an inpatient or day case basis and is successful 85-90% of the time.

History[edit]

The first recorded attempt at repairing the tympanic membrane was made by Marcus Banzer^[4] in 1640 using an ivory tube covered by pig's bladder.

Artificial tympanic membranes[edit]

In the middle of the nineteenth century the British otologists James Yearsley and Joseph Toynbee each developed their own form of artificial eardrum. Despite initial enthusiasm for these devices, experience amongst the medical profession over the following half century demonstrated their minimal value in the treatment of a perforated eardrum.^[5] But this generally heals naturally .

References[edit]

^ Wullstein, H. (1956), Theory and practice of tympanoplasty. The Laryngoscope, 66: 1076–1093. doi:10.1288/00005537-195608000-00008
^ "Tympanoplasty or Myringoplasty". Surgerynet. Retrieved 13 August 2012.
^ Browning GG, Merchant SN, Kelly G et al. Chronic otitis media. In: Gleeson M, ed. Scott-Brown's Otorhinolaryngology Head and Neck Surgery. London: Hodder Arnold, 2008:3395-445
^ Banzer, M. (1640) Disputatio de auditione laesa (Disertation on deafness]
^ Chu, EA and Jackler, RK (2003) The Artificial Tympanic Membrane (1840-1910): From Brilliant Innovation to Quack Device. Otology & Neurotology 24:507-518

External links[edit]

PERFORATIONS AND HEARING LOSS - Ear Surgery Information Center
Ruptured eardrum: Treatment - MayoClinic.com
Tympanoplasty diagram & animated GIF
Tympanoplasty Informed Consent - discusses risks of tympanoplasty & related procedures.
Tympanoplasty - A First hand experience

UpToDate Contents

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English Journal

Biocompatibility of silver containing silica films on Bioverit® II middle ear prostheses in rabbits.

Duda F1, Bradel S1, Bleich A2, Abendroth P3, Heemeier T3, Ehlert N3, Behrens P3, Esser KH4, Lenarz T1, Brandes G5, Prenzler NK1.
Journal of biomaterials applications.J Biomater Appl.2015 Jul;30(1):17-29. doi: 10.1177/0885328215570103. Epub 2015 Feb 6.
For several centuries silver is known for its antibacterial effects. The middle ear is an interesting new scope for silver application since chronic inflammations combined with bacterial infection cause complete destruction of the fragile ossicle chain and tympanic membrane. The resulting conductive
PMID 25659947

Response to Comment on "Efficacy of Tympanoplasty Without Mastoidectomy on MRSA-infected Chronic Otitis Media".

Yang HC1, Cho YB, Jang CH.
Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.Otol Neurotol.2015 Jul;36(6):1124-1125.
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Japanese Journal

鰓弓耳腎症候群例

桝井貴史,家根旦有,中井義紀,太田一郎,細井裕司
耳鼻咽喉科臨床 107(1), 65-69, 2014
… As the rate of improvement in hearing loss by surgical treatment such as tympanoplasty is not necessarily high, we should decide the indication for surgery carefully. …
NAID 130003386116