Types of Tympanoplasty - Wullstein Classification

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🦻 Types of Tympanoplasty – Wullstein Classification

Tympanoplasty is the surgical reconstruction of the hearing mechanism of the middle ear, typically due to chronic otitis media.

Wullstein classified tympanoplasty into five types, based on:

The site of defect
The status of the ossicular chain
Where the graft is placed

Types of Tympanoplasty Diagram

📘 Type 1 Tympanoplasty

🦴 Ossicles: Intact (Malleus, Incus, Stapes)
🕳️ Defect: Only tympanic membrane perforation
🩹 Graft Placement: On the remnant tympanic membrane or on the handle of malleus

📘 Type 2 Tympanoplasty

🦴 Ossicles: Malleus is eroded, incus and stapes are intact
🕳️ Defect: Tympanic membrane + Malleus
🩹 Graft Placement: On the incus or remnant of the malleus

📘 Type 3 Tympanoplasty

🦴 Ossicles: Malleus and incus are absent, only stapes suprastructure is present
🩹 Graft Placement: Directly over the stapes suprastructure
✅ Alternate Names:
- Columella tympanoplasty
- Myringostapediopexy

📘 Type 4 Tympanoplasty

🦴 Ossicles: Malleus, Incus, and stapes suprastructure are absent
Only the footplate of stapes is present
🩹 Graft Placement: Between the oval window and round window
🌀 Middle Ear Cavity: A narrow air-filled space is created called Cavum Minor
✅ Concept: Protects round window from direct sound energy to preserve phase differential

📘 Type 5 Tympanoplasty

🦴 Ossicles: Stapes footplate is present but fixed
🌀 Round Window: Still functional
🪟 Surgical Approach: A new window is created on the lateral semicircular canal
🩹 Graft Placement: Over this newly created fenestra
✅ Alternate Name: Fenestration operation

🧠 Types of Tympanoplasty - Summary Table

Type	Ossicular Status	Graft Placement	Alternate Name
1	All ossicles intact	Over tympanic membrane / malleus	-
2	Malleus eroded	Over incus or remnant malleus	-
3	Malleus + incus absent	Over stapes suprastructure	Myringostapediopexy / Columella
4	Only stapes footplate present	Between oval & round window	Cavum minor creation
5	Fixed stapes footplate	New window on lateral semicircular canal	Fenestration operation

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