Classification of Tympanoplasty:

• Type I: Defect in the tympanic membrane is repaired by a graft after checking the mobility and status of the ossicular chain. It is also called Myringoplasty.
• Type II: There is perforation of tympanic membrane with erosion of malleus or part of incus.
• Type II a: Graft is kept touching the malleus remnant, incus or Incudo-stapedial joint.
• Type II b: Here the incus is also diseased. The body of the incus is refashioned to fit into the stapes head. The short process of incus goes under the handle of malleus.
• Type III: Malleus and Incus are absent.
• Type III a: Low facial ridge: Graft is kept below the level of malleus touching the stapes head, called Myringostapediopexy.
• Type III b: High facial ridge: Graft not directly touching the stapes head but below the level of malleus.
• Type IV: Only the footplate of stapes is present, exposed to the external ear, and graft is placed in between oval and round windows. A narrow middle ear, cavum minor, is made to have an air pocket around the round window. Sound waves act directly on the footplate while round window has been shielded.

• Type V: Stapes footplate is fixed but round window is functioning. Here another window is created on lateral semicircular canal and covered with a graft. It is also called fenestration operation.
• Type VI: Sono-Inversion: All sound waves enter through the round window keeping the oval window covered (reverse direction).

Most common grafts used in Tympanoplasty:

• Temporalis fascia - most common.
• Cartilage.
• Perichondrium.
• Fascia Lata.

Incision approach for Tympanoplasty:

• Endaural approach.
• Postaural approach.
• Endomeatal (Transcanal) approach.

Anesthesia for Tympanoplasty:

• Usually done in local anesthesia.
• General anesthesia can be used in uncooperative patients.

Techniques of placement of Graft in Tympanoplasty:

• Underlay technique.
• Overlay technique.
• Interlay technique.
• Double breasting technique.