What is Tympanoplasty / Mastoidectomy?
Tympanoplasty is the surgical repair of a perforated tympanic membrane (eardrum) using a tissue graft, frequently combined with ossiculoplasty (reconstruction of the tiny ear ossicles). When chronic infection extends into the honeycombed air cells of the mastoid bone behind the ear, a mastoidectomy is performed concurrently. Mastoidectomy drills out diseased bone, cholesteatoma (destructive skin cysts), and infected granulation tissue to create a safe, dry, and healthy ear cavity.
Who Needs Tympanoplasty / Mastoidectomy?
Surgery is indicated for chronic otitis media (CSOM) that fails conservative antibiotic ear drops, or when cholesteatoma threatens inner ear and intracranial structures.
Key clinical indicators include:
- Persistent or recurrent foul-smelling ear discharge (otorrhea).
- Permanent central or marginal eardrum perforation.
- Conductive hearing loss caused by eardrum disruption or damaged ossicles.
- Cholesteatoma (unsafe CSOM with risk of bony erosion).
- Complications of ear infection such as facial weakness, vertigo, or mastoid abscess.
Types & Surgical Variations
- Tympanoplasty Type I (Myringoplasty): Grafting of eardrum perforation with an intact, normal ossicular chain.
- Tympanoplasty Type II - V (Ossiculoplasty): Reconstruction of eroded middle ear bones using titanium or cartilage prostheses.
- Cortical (Simple) Mastoidectomy: Drilling out mastoid air cells while keeping the canal wall intact.
- Modified Radical / Canal Wall Down Mastoidectomy: Removal of the posterior canal wall to create a single open cavity for extensive cholesteatoma disease.
Benefits of Tympanoplasty / Mastoidectomy
- Elimination of chronic, foul-smelling ear discharge and infection.
- Restoration of eardrum integrity, allowing safe swimming and bathing without water entry.
- Improvement or stabilization of hearing thresholds.
- Prevention of life-threatening complications such as brain abscess, meningitis, or facial nerve palsy.
What to Expect Before Surgery?
Pre-operative workup ensures precise surgical planning:
- Audiogram: Pure Tone Audiometry (PTA) to establish pre-operative conductive vs sensorineural hearing levels.
- HRCT Temporal Bone: High-resolution CT scan to assess ossicular integrity, mastoid pneumatization, and cholesteatoma extent.
- Ear Dryness: Medical treatment with topical ear drops to secure a dry ear prior to grafting.
- Anesthesia Clearance: Routine blood investigations, ECG, and chest X-ray.
Complete Procedure
The procedure is performed under general or local anesthesia with sedation, lasting 1.5 to 3 hours:
- Making a incision behind the ear (post-auricular) or inside the ear canal (transcanal).
- Harvesting a tissue graft (typically temporalis fascia, tragal cartilage, or perichondrium).
- Elevating the tympanomeatal flap to inspect the middle ear cavity and ossicular chain.
- (If Mastoidectomy required) Drilling the mastoid bone behind the ear to remove all infected air cells or cholesteatoma matrix.
- Positioning the harvested graft under or over the eardrum perforation (underlay vs overlay technique).
- Reconstructing damaged middle ear bones with synthetic micro-prostheses if necessary.
- Packing the ear canal with medicated gelfoam sponges and closing external incisions.
What to Expect During Surgery?
The surgery is performed under high-power operating microscope or endoscopic visualization. Nerve monitoring is frequently utilized to safeguard the facial nerve traversing the mastoid bone.
Endoscopic vs Microscopic Ear Surgery
| Feature | Microscopic Surgery | Endoscopic Ear Surgery |
|---|---|---|
| Incision | Often requires post-auricular cut behind the ear. | Transcanal approach directly through ear canal (no external scar). |
| Visualization | Straight line-of-sight view. | Wide-angle view around middle ear corners. |
| Graft Placement | Excellent for complex mastoidectomies. | Ideal for isolated tympanoplasties and limited disease. |
| Recovery | Mild post-auricular bandage for 24-48 hours. | Minimal external wound dressing and rapid recovery. |
Success Rate and Safety
Tympanoplasty has a successful graft take rate of 85% to 95%. Mastoidectomy successfully eradicates infection and cholesteatoma in over 90% of primary cases.
Tympanoplasty / Mastoidectomy Cost Estimate
| Procedure Type | Standard Technique (INR) | Advanced / Endoscopic / Prosthetic (INR) |
|---|---|---|
| Standalone Tympanoplasty (Myringoplasty) | ₹45,000 - ₹75,000 | ₹65,000 - ₹1,10,000 |
| Tympanoplasty + Ossiculoplasty | ₹60,000 - ₹1,00,000 | ₹85,000 - ₹1,40,000 |
| Tympanomastoidectomy (Combined) | ₹75,000 - ₹1,25,000 | ₹1,10,000 - ₹1,80,000 |
Disclaimer: Final pricing depends on prosthesis type (titanium vs cartilage), surgeon expertise, and hospital stay.
Recovery Guide & Post-Operative Care
Recovery Timeline
- Day 1: Discharge home; head bandage removed; ear felt full or stuffed due to internal gel packing.
- Week 1-2: Incision healing behind ear; stitch removal; avoid any water entering the ear.
- Week 3-4: In-clinic removal of absorbable ear canal packing; initial evaluation of graft integration.
- Month 2-3: Follow-up audiogram to measure hearing improvement and complete healing.
Post-Op Precautions & Care
- Water Protection: Absolutely keep the operated ear dry; use cotton balls coated with petroleum jelly during showers.
- Avoid Nose Blowing: Do not blow your nose forcefully; sneeze with an open mouth to prevent graft displacement.
- Avoid Air Travel: Refrain from air travel or high-altitude mountain drives for 4 to 6 weeks.
- No Heavy Lifting: Avoid strenuous physical exercise or straining for 3 weeks.
Frequently Asked Questions
Will my hearing improve immediately after tympanoplasty?⌄
No. Hearing feels reduced initially due to blood clots and gel packing in the ear canal. Hearing improvement is evaluated 6 to 8 weeks after packing absorbs.
How long do I need to keep water out of my ear?⌄
You must strictly protect the ear from water until your ENT surgeon confirms complete graft healing, usually 6 to 8 weeks post-surgery.
What is cholesteatoma and why does it need mastoidectomy?⌄
Cholesteatoma is an abnormal skin growth behind the eardrum that gradually erodes surrounding ear bones and skull base. Mastoidectomy is required to clear it safely.
Can I fly on an airplane after ear surgery?⌄
You should avoid air travel for 4 to 6 weeks post-surgery to prevent cabin pressure changes from dislodging the delicate ear graft.
Is tympanoplasty performed under general or local anesthesia?⌄
It can be performed under local anesthesia with sedation for adults, while general anesthesia is preferred for children and complex mastoid cases.