Experience Summary

In this 360-degree video, observe a child with a small anterior inferior tympanic membrane perforation undergo an endoscopic tympanoplasty.

Clinical Context

Tympanoplasty is a surgical procedure aimed at repairing defects of the tympanic membrane (eardrum) and, in some cases, the ossicular chain within the middle ear. It is primarily performed to restore hearing function and to prevent recurrent infections or chronic otorrhea (discharge) resulting from a perforated eardrum. This procedure plays a crucial role in the management of chronic otitis media (COM), particularly in cases where conservative medical treatments have failed or where structural damage compromises hearing and ear health.

Chronic tympanic membrane perforations can arise from repeated middle ear infections, traumatic injury, or iatrogenic causes such as previous ear surgeries. Patients often present with symptoms such as hearing loss, intermittent ear discharge, ear fullness, and, in some cases, tinnitus. Tympanoplasty is considered when these symptoms significantly affect the patient's quality of life or when there is a risk of more serious complications, such as the development of cholesteatoma — a destructive, abnormal growth of squamous epithelium within the middle ear that can lead to erosion of surrounding structures.

The procedure is indicated for patients with persistent perforations that have not healed spontaneously after three months, especially in the presence of conductive hearing loss or recurrent infections. It is also considered in the presence of ossicular chain disruption, which contributes to significant hearing impairment. Tympanoplasty is often performed as part of a broader surgical intervention that may include mastoidectomy if there is extensive middle ear or mastoid disease.

A successful tympanoplasty not only restores the integrity of the tympanic membrane but also improves conductive hearing by re-establishing the sound transmission pathway. Various graft materials, including temporalis fascia, cartilage, or perichondrium, are used to patch the perforation. The surgical approach (transcanal, postauricular, or endaural) depends on the size and location of the perforation, the status of the ossicles, and the surgeon's preference and expertise.

It is essential to assess patients thoroughly before surgery, including audiological evaluation and imaging studies such as CT scans if cholesteatoma or ossicular erosion is suspected. The overall goal of tympanoplasty is to achieve a dry, infection-free ear with the best possible hearing outcome, thereby significantly improving the patient's functional status and quality of life.

Learning Outcomes

1. Observe an endoscopic tympanoplasty on a child.
2. Understand the team members involved in the care of this patient.
3. Revisit key steps involved in the procedure and the equipment needed to safely perform this.

External Resources

• [Endoscopic or Microscopic Tympanoplasty Advantages and Disadvantages: A Theory Domain Systematic Review](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411212/#:~:text=Endoscopic type I tympanoplasty can,technique for tympanic membrane perforations.&text=ET is a conservative and,with a good postoperative ABG.))
• Endoscopic tympanoplasty - PMC Article