Tympanoplasty | Surgery for COM/Eardrum Perforation | Malayalam | Dr. Vivek Sasindran скачать в хорошем качестве

Tympanoplasty | Surgery for COM/Eardrum Perforation | Malayalam | Dr. Vivek Sasindran

Dr. Vivek Sasindran, Consultant ENT, Head and Neck Surgeon Today's topic of discussion is Tympanoplasty, a surgical procedure aimed at treating Chronic Otitis Media. Chronic Otitis Media often leads to ear discharge and can be classified as Mucosal or Squamosal. In simpler terms, Mucosal Chronic Otitis Media refers to a perforation or hole in the eardrum, also known as the tympanic membrane. This condition causes frequent ear discharges and hearing loss. When patients experience hearing loss or have a history of discharge lasting three months or more, a diagnosis of Chronic Otitis Media is made, and surgical treatment is usually recommended. The surgical options for treatment involve either closing the perforation in the ear or reconstructing the eardrum. There are various options available for reconstructing the eardrum. The surgical procedure used for this purpose is called Tympanoplasty, which aims to both reconstruct the eardrum and improve hearing. For reconstructing the eardrum, we commonly use a material called Fascia, which is located in the same area of the ear and shares similarities with the eardrum. This material is harvested from behind the ears. Additionally, Cartilage near the ear, the lining over the Cartilage called Perichondrium, or Fat can be used for small perforations. Generally, we utilize locally available materials for reconstruction. Tympanoplasty can be performed under General Anesthesia or Local Anesthesia with IV Sedation. General Anesthesia is preferable for apprehensive patients. In cases where General Anesthesia poses difficulties, such as with high-risk patients or those with multiple medical issues, the procedure can be performed under Local Anesthesia. There are two surgical options based on technique. Microsurgery, performed with the assistance of a Microscope, has been a widely used method for years. This procedure involves an incision behind the ear, which is then sutured and closed. The advantage of this technique is that the incision mark is cosmetically acceptable as it is located behind the ear and not visible. Alternative options include making an incision in the front portion of the ear or utilizing Endoscopic Ear Surgery. However, regardless of the chosen method, the graft used for reconstruction is taken from another site. For instance, if the endoscopic method is selected, a separate incision would be necessary to harvest the Fascia. The choice of technique depends on the tools used: Endoscopic Ear Surgery if an endoscope is employed, or Microscopic Ear Surgery if a microscope is used. The magnification provided by these tools is essential due to the small size of the ear and limited working space. Typically, a new material is used to graft the eardrum, and the healing period lasts approximately four to six weeks. Most patients can return home the day after surgery. It is important for patients to be cautious and avoid wetting the incision or suture site. While they can resume their daily routines, strenuous activities, heavy lifting, blowing their nose forcefully, and allowing water into the ears should be avoided. During the four to six-week healing period, patients are advised to place cotton inside their ears to prevent water from entering. Stitches are usually removed after one week, after which patients can wash their heads. Following successful surgery, as mentioned earlier, hearing improvement and dryness of the ears should be expected.