Endoscopic Tympanoplasty and Ossiculoplasty - Reconstruction of the Eardrum and Ossicles

Endoscopic reconstruction of the eardrum and auditory ossicles 

Minimally invasive approach. Precise reconstruction. Functional preservation.
Endoscopic tympanoplasty and ossiculoplasty are modern surgical methods used to reconstruct damaged eardrums and ossicles, aiming to restore or improve hearing and middle ear function.

What is tympanoplasty? 

Tympanoplasty is a surgical procedure used to reconstruct a damaged eardrum (tympanic membrane) and when necessary, the ossicles of the middle ear. This procedure is indicated in cases of:

• eardrum perforations (ruptures) that do not heal spontaneously
• chronic middle ear infections with eardrum perforation
• retraction pockets and eardrum atrophy
• damage to the eardrum and middle ear following cholesteatoma
• conductive hearing loss due to damage to the eardrum and/or ossicular chain

Ossiculoplasty – reconstruction of the ossicular chain 

Ossiculoplasty is a reconstructive middle ear surgery used to rebuild the ossicular chain (malleus, incus, stapes). This procedure is often performed alongside tympanoplasty in cases of:

• disruption of the ossicular chain due to trauma or chronic inflammation
• erosion or damage of the ossicles caused by cholesteatoma
• fixation of ossicles due to tympanosclerosis
• conductive hearing loss despite an intact eardrum

Advantages of the endoscopic approach

At St. Catherine Specialty Hospital we perform endoscopic tympanoplasty and ossiculoplasty whenever possible, offering significant advantages:

• minimally invasive – the procedure is performed through the ear canal without external incisions
• enhanced visualization – endoscopes provide excellent views of all middle ear structures
• precise reconstruction – improved visibility allows for more accurate repair of damaged structures
• tissue preservation – targeted access avoids unnecessary removal of healthy tissue
• lower postoperative morbidity – less pain and discomfort after surgery
• faster recovery – shorter healing time and quicker return to daily activities
• better functional outcomes – more precise reconstruction can result in better hearing results

Individualized approach to reconstruction 

Mislav Malić, M.D., Ph.D., FEBORL-HNS, otorhinolaryngology specialist, with experience in ear reconstructive surgery, selects the most appropriate technique for each patient. Reconstruction may involve:

• autologous tissue – using the patient’s own tissue (fascia, cartilage, perichondrium)
• partial or total ossicular prostheses – for reconstruction of the ossicular chain
• combined approach – endoscopic, microscopic or a hybrid technique depending on the case

The choice of surgical technique depends on:

• type and extent of eardrum damage
• condition of the ossicular chain
• patient’s anatomical specifics
• previous surgeries
• cause of conductive hearing loss

Procedure and Recovery 

Tympanoplasty and ossiculoplasty are performed under general anesthesia and typically involve:

1. Access to the middle ear through the ear canal or when needed, via an incision behind the ear
2. Preparation of the graft bed (tissue used to reconstruct the eardrum)
3. Evaluation and reconstruction of the ossicular chain, if necessary
4. Placement of the graft to reconstruct the eardrum
5. Stabilization of the graft and closure of the surgical site

Recovery following endoscopic tympanoplasty and ossiculoplasty is usually faster compared to traditional approaches. Hearing improvement can typically be expected within 6–8 weeks after surgery, once the reconstructed eardrum has healed and inflammation has subsided.

If you have an eardrum perforation, chronic middle ear infections or conductive hearing loss, feel free to contact us for a diagnostic evaluation and consultation regarding ear reconstructive surgery options.