Types of Tympanoplasty - Wullstein Classification

🦻 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

📘 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