Tympanoplasty

1. Tympanoplasty

2. •Definition
•Classification

3. •Definition
–Surgery for reconstruction of tympnic
membrane and/or ossicles
•Classification
–Wullstein (1956)
–Austin and Kartush

4. Wullstein
1
2
3
4
5

5. Middle ear risk index
•MERI to predict the success rate.
•For accurate prediction of the results of
ossiculoplasty the status of middle ear and
its ossicles must be ascertained.
–Austine Kartush classification
–TM perforation
–Cholesteatoma
–Belluci classification

6. Austine Kartush
•Group A - Malleus and stapes present
•Group B - Malleus and foot plate of stapes
present
•Group C - Malleus absent and stapes
present
•Group D - Malleus and stapes
suprastructure absent

7. Austine Kartush
•Kartush added 3 more classes as a
modification of this scheme in include
ossicular fixity even when all three
ossicles are present.
•O - Intact ossicular chain
•E - Ossicular head fixation
•F - Stapes fixation

8. Belluci classification

9. MERI

10. •Indications
•What are you trying to achieve?

11. Indication
–TypeI-perf/ discharge/
conductive loss/
–Types II-IV-perf/
significant conductive
loss/ part of middle ear
surgery for
cholesteotoma/
CSOM/
–TypeV-stapes
footplate fixation
Contracindiction
–no cochlear function
–Neoplasm of middle
ear or EAC
–Malignant OE
–Only hearing ear or sig
better H Ear
•Relative contra
–EU dysfunction, very
young
–Chonic ear discharge
–If no sig hearing
improvement possible
with no hx of CSOM
–Pt factors-smoker etc,
diabetes

12. •Patient assessment
–History
–Examination
–Investigations

14. What is:
•Belfast rule of thumb?
•Glasgow benefit plot

15. What are these?
What is a TORP? PORP?

18. Common situations - options
•Simple perforation (1)
•Austin A M+S+ (1)
•Austin B M+S- (?)
•Footplate fixed (3)
•Austin D M-S- (4)

22. •What are prognostic factors?
–Black SPITES
–Or MER

23. Prognosis
Risk Factor Risk Value
Otorrhea (Belucci)
I. Dry 0
II. Occasionally wet 1
III. Persistently wet 2
IV. Wet, cleft palate 3
Perforation
Absent 0
Present 1
Cholesteatoma
Absent 0
Present 1

24. Ossicular status (Austin/Kartush)
O: M+I+S+ (intact ossicular chain) 0
A: M+S+ (malleus present, stapes present) 1
B: M+S- (malleus present, stapes absent) 2
C: M-S+ (malleus absent, stapes present) 3
D: M-S- (malleus absent, stapes absent) 4
E: Ossicle head fixation 2
F: Stapes fixation 3

25. Middle ear - Granulations or effusion
No 0
Yes 1
Previous surgery
None 0
Staged 1
Revision 2

26. Prognosis/Risk MER Index
Best prognosis (normal ear) 0
Mild risk 2
Moderate risk 5
Severe risk 7
Worst prognosis (end stage) 12

27. •Postoperative care
•Results
•Complications