Question
Is there any evidence to suggest that tympanograms should not be undertaken after myringoplasty?
Answer
A Medline review of the literature does not find any evidence that tympanometry should not be performed after myringoplasty or tympanoplasty. There is extensive discussion on the use of tympanometry to follow eustachian tube dysfunction (ETD) after tympanoplasty, but this is following the ETD over the long term.
I may be misinterpreting, the question, but I believe the requestor may be asking when is it safe to proceed with tympanomety after myringoplasty. Will early tympanometry jeopardize the success after myringoplasty? The answer is it depends on the technique and the nomenclature.
If the procedure was a simple paper patch myringoplasty, performing a tympanogram sooner than 4 to 6 weeks after the procedure may indeed jeopardize the successful closure of the perforation. If a fat graft myringoplasty is performed then, to be safe, waiting 4 to 6 weeks would be prudent, but there is probably no danger even if the tympanogram is done a few days or a week after the procedure. If temporalis fascia is used to repair the perforation, particularly if the ear canal is packed, then there is no danger to the graft, but the test will not give any information of value. This is similar to a tympanogram on a patient with an ear canal with complete cerumen impaction. It will yield a type B tympanogam with low volume, but will not reflect any information on the status of the tympanic membrane or middle ear.
Which leads to the underlying question or problem not addressed by the question -- Specifically -- what information is needed by the team taking care of the patient?
What information is the audiologist/otologist/otolaryngologist trying to obtain?
With few, very unusual exceptions, the information that is needed in the early postoperative period is what is the bone conduction in the operative ear. Air conduction and tympanometry are best deferred for 4 to 6 weeks after the procedure when they give more useful information.
Communication between the operative surgeon and the hearing professional is essential to clear up any questions concerning the reason for the test, the procedure performed and the clinical question raised.
Charles Augustine Syms, M.D.
Dr. Syms practices Otology/Neurotology at the Ear Medical Group in San Antonio, Texas and is an active educator as a Clinical Associate Professor at the University of Texas Health Science Center at San Antonio. He is a Board Certified Otolaryngologist with fellowship training at the House Ear Clinic in the specialties of Otology, Neurotology and Skull Base Surgery. He limits his private practice to the medical and surgical treatment of diseases of hearing, balance, cranial nerves, and tumors of the base of the skull. Dr. Syms has authored 16 articles and 7 book chapters.
He is actively involved in the research of pediatric ear disease, skull base tumors, balance disorders, cochlear implants and otitis media, as well as the implementation of humanitarian care missions and cost effective medical care.