What is the role of tympanoplasty in the treatment of tympanic membrane perforation (TMP)?

Updated: Dec 14, 2020
  • Author: Robert A Saadi, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The second option is to perform tympanoplasty with the patient under local or general anesthesia. An incision may be made behind the ear or entirely through the ear canal, depending on the location and size of the TMP. Repair requires preparation of a suitable bed for placement of a graft. By far, the most commonly used grafting material is temporalis fascia. Allograft tympanic membranes obtained from cadavers, once abandoned because of fear of transmitting viral pathogens, are again being used. Grafts may be placed medially or laterally to the perforation, or in a combined position. [6] Surgeon preference plays a part in these decisions and in decisions concerning the technical problems associated with size and location of the perforation and the shape, angle, and bore of the ear canal.

Tympanoplasty successfully closes the tympanic membrane perforation (TMP) in 90-95% of patients. Fortunately, second and third operations succeed in more than 90% of the remaining patients. Consequently, fewer than 1 per 1000 persons still has tympanic membrane perforation (TMP) after 3 operations.

A retrospective study by Carr et al indicated that in adults undergoing myringoplasty (type 1 tympanoplasty), the perforation site affects the success of the procedure, with the closure rate significantly reduced for anterior and subtotal perforations. In the study’s pediatric patients, however, the perforation site appeared to have no such affect. [26]

A study by Tseng et al reported successful subjective and objective outcomes in tympanic perforation repair with endoscopic transcanal myringoplasty. Graft success was achieved by 3 months postoperatively in 87.9% of ears, with the air-bone gap closed to within 20 dB in 86.8% of ears. Pain medication was used for a mean duration of 2.0 days, with the mean pain scale score determined to be 0.1 on the third postoperative day. [27]

A retrospective study by Larrosa et al indicated that in the transcanal, endoscopic repair of subtotal tympanic membrane perforations (TMPs) in adults, results from the use of palisade cartilage grafts are comparable to those from employment of the one-piece composite cartilage-perichondrium technique, with closure rates of 85% and 86.3%, respectively. Hearing improvement was also similar with both techniques. [28]

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