---
title: "Types of Tympanoplasty - Wullstein Classification"
description: "A complete guide to the Wullstein classification of tympanoplasty. Detailed notes on all 5 types - for MBBS and ENT PG students."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/types-of-tympanoplasty"
categories: ["Otology", "Short Questions in ENT", "Drawings in ENT"]
video: "https://www.youtube.com/watch?v=PIkXCy50uoQ"
image: "https://media.theentresident.com/og-images/types-of-tympanoplasty.png"
---

# Types of Tympanoplasty - Wullstein Classification

A complete guide to the Wullstein classification of tympanoplasty. Detailed notes on all 5 types - for MBBS and ENT PG students. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=PIkXCy50uoQ

## 🦻 Types of Tympanoplasty – Wullstein Classification

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

The most widely accepted tympanoplasty classification was proposed by Wullstein. It divides the procedure into **five types** based on:

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

![Types of Tympanoplasty Diagram](https://media.theentresident.com/post-images/types-of-tympanoplasty.png)

*The diagram above illustrates the five types in Wullstein classification of tympanoplasty.*

### 📘 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 Names**:
  - Fenestration operation
  - Fenestration tympanoplasty

---

## 🧠 Tympanoplasty Types - 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 tympanoplasty |
| 4 | Only stapes footplate present | Between oval & round window | Cavum minor creation |
| 5 | Fixed stapes footplate | New window on lateral semicircular canal | Fenestration tympanoplasty |

---

## About This Note

This free ENT note on Types of Tympanoplasty - Wullstein Classification was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/types-of-tympanoplasty

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Otology: https://www.theentresident.com/ent-notes-lectures/category/otology.md
- Short Questions in ENT: https://www.theentresident.com/ent-notes-lectures/category/short-questions-in-ent.md
- Drawings in ENT: https://www.theentresident.com/ent-notes-lectures/category/drawing-in-ent.md

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