Types of tympanoplasty of the ear according to Vulstein: reviews, rehabilitation, complications

Often a person who has received a serious injury to the middle ear, it becomes necessary to seek help with surgery. In this case, only tympanoplasty can help a patient. This procedure is quite common in medicine practice, which allows you to effectively and quickly restore the perforation of the tympanic membrane.


Timpanoplasty is a surgical procedure. It allows to restore the structure and position of internal auditory ossicles, including an anvil, stapes, a hammer.

At the final stage, myringotomy and restorative process of the tympanic membrane is performed. The tympanic membrane is an incredibly vulnerable part of the hearing aid. To lead to its damage can be various kinds of infection, trauma.


Timpanoplasty is prescribed for patients who have significant damage to the sound transmission system. So, this may include mechanical damage of a particular severity, infectious, purulent inflammatory processes.

Ear structure

Types of operation

Timpanoplasty is of several varieties. For each of them, there are assignments and testimonies. The nature of the operation depends on the type and degree of damage to the ear. In medicine, the main 5 types of operations, corresponding to the classification of Professor Vulstein, are distinguished, which are shown to patients with characteristic damages of the tympanic membrane and auditory ossicles.


This kind of sanitizing operation allows to eliminate obvious defects of the tympanic membrane. Transmeal plastic type 1 is performed through the external auditory meatus. The operation helps with minor damages, which can be eliminated with minimal effort. Assign also a procedure to the patient in an intact chain of auditory ossicles.


Type 2 operation, called attico-anthotomy, is assigned if the auditory ossicle is damaged, but with auditory stirrups. The procedure is carried out using a free graft in a gentle manner.


Operation type 3 of the radical type is carried out by implanting a flap into a place where there is no part of the tympanic membrane. There is an introduction of columella between the hammer, the eardrum transplant and stapes. Thus, the patient creates his own simplified tympanal system.


A radical operation is performed with severe defects in the middle ear. As an artificial flap is preserved part of the eardrum. It is framed with an osseous ring or is then planted near an open oval window.


Fenestration of the auditory canal is performed. An operation is prescribed in the absence of all auditory ossicles. Also in most cases, the operation involves removing the fixed base of the stapes and introducing adipose tissue into the necessary areas.

Types of tympanoplasty

Preparation and preliminary examinations

Preparatory activities involve the patient's passage of all necessary research. This includes not only a general anamnesis, which the doctor receives from his patient. Also, a number of studies are carried out to determine the degree of damage, the strength of the inflammatory process and the possible threat of progress of complications.

So, to obtain a complete clinical picture, such studies can be conducted:

  • radiography of the temporal bones;
  • omicroscopy;
  • audiometry;
  • definition of the functional state of the vestibular apparatus;
  • general condition of the patient;
  • blood test results;
  • study of the microflora of the middle ear.
In many respects the success of the operation depends on the degree of preparedness of the otosurgeon, the equipment of the operating room, and also on the availability of the necessary equipment.

The outcome of the operation will be affected by the amount of surgical intervention, as well as its step-by-step.

Technique for conducting

The operation involves a complex and part of the jewelry process. In the course of it a microscope of a special type is inserted into the auditory meatus. Further surgical intervention occurs with its help. A small cut is made above the ear. A small piece of skin is extracted from it, which later serves as a flap for processing the tympanic membrane.

After that, put a tampon moistened with antibiotic in the ear. This is done to ensure that the implanted flap takes root in a new place. Fully operation takes no more than an hour. After a few weeks, the patient is completely restored.

Technique of tympanoplasty in our video:

Recovery period

Recovery after surgery takes about 2-3 weeks. During this period the patient should be at rest. Strictly forbidden:

  • air travel;
  • blowing;
  • bathing in swimming pools, sea, river;
  • supercooling;
  • weight lifting.

Kind of eardrum before and after procedure

What can not be done

Do not ignore the doctor's recommendations during treatment and the entire recovery period. Strict adherence to the prescribed rules will allow you to recover faster. While the ear is actively healing it is best to postpone possible travel and travel for long distances.

Stress and possible hypothermia should be avoided. The ear is best isolated with a sterile swab or bandage.

In case of any unpleasant pain, noise, congestion and suspicious symptoms, you should immediately contact a doctor.

Possible complications of

Complications after tympanoplasty are rare. However, no one is immune from their manifestation. In the event that the operation was performed by an insufficiently qualified doctor, infection of the middle ear area is possible. Often the occurrence of chronic acute otitis media. Nerve damage can also occur.

Among the dangerous symptoms after the operation are:

  • pain;
  • tingling;
  • temperature increase;
  • selection;
  • burning sensation.

Of the usual complications that may occur after surgery, isolate hearing loss. This is a common symptom that manifests itself depending on how actively the eardrum heals.

Reviews of tympanoplasty and the diagnostic value of the procedure:


The operation is not available to all patients. So, carrying out of procedure can be dangerous, up to that provokes serious deterioration of hearing.

So, contraindications for tympanoplasty are as follows:

  • exacerbation of chronic otitis media;
  • intracranial complications;
  • strong inflammatory processes;
  • the patient has tuberculosis, diabetes, thyroid disease.

The attending doctor must necessarily detect and fix all the existing problems with the patient's health. Otherwise, the operation will not only bring the desired result, but it will also hurt.

Diagnostic value of

Proper tympanoplasty allows to restore lost hearing. In successful cases, audibility can rise to 30 dB, and sometimes tympanoplasty is combined with the installation of a sound reinforcement element or implant. The main task of this type of operation is the prevention and prevention of inflammatory processes occurring inside the ear.

Therefore, in order to get quality and really effective services, you should contact strictly qualified doctors. It should be remembered that until the beginning of treatment and the appointment of the date of the operation, the doctor is obliged to conduct all necessary studies, starting from a banal examination and ending with the surrender of blood biochemistry.

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