Expected Findings and Complications After Tympanoplasty and Mastoidectomy

The postoperative imaging evaluation of patients who have undergone tympanoplasty and mastoidectomy with or without ossicular reconstruction is often challenging due to variations in techniques and implanted materials. Although most small, acute tympanic membrane perforations heal spontaneously, chronic or larger perforations often necessitate surgical repair. This will vary from simple grafting of the tympanic membrane (myringoplasty) to various types of ossiculoplasty and mastoidectomy, with or without takedown of the posterior and superior walls of the external auditory canal. Potential complications include those that affect the residual tympanic membrane or graft and include thickening, retraction, reperforation, and ossification. If a cholesteatoma is present before surgery, it can be left behind after procedures with suboptimal visibility (eg, canal wall up mastoidectomy) and may require second-stage surgery, but it can also develop from new tympanic retraction pockets. Cholesteatoma is expansile and erosive, and may lead to dehiscence of the facial nerve canal, semicircular canal, tegmen tympani, or erosion of residual ossicles among other structures. Prostheses used for ossicular reconstruction are varied and have their own range of adverse outcomes, such as displacement and extrusion. Here, we describe the expected postoperative findings and complications in the temporal bone after tympanoplasty and mastoidectomy.

Learning Objective: Recognize expected postoperative findings in the temporal bone and common complications after tympanoplasty.