Tympanoplasty is a surgical procedure to reconstruct the tympanic membrane and/or ossicles that have been damaged. It is classified based on the status of the ossicles and middle ear, such as the Wullstein and Austin-Kartush classifications, which help determine the surgical approach and predict success rates. Factors like the presence of otorrhea, perforation, cholesteatoma, and ossicular chain status are used to calculate a Middle Ear Risk Index that provides a prognosis for tympanoplasty outcomes.

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 Contracindiction
– no cochlear function
– TypeI-perf/ discharge/ – Neoplasm of middle
conductive loss/ ear or EAC
– Types II-IV-perf/ – Malignant OE
significant conductive – Only hearing ear or sig
loss/ part of middle ear better H Ear
surgery for • Relative contra
cholesteotoma/ – EU dysfunction, very
CSOM/
young
– TypeV-stapes
– Chonic ear discharge
footplate fixation
– 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