Dr. William J. Parkes IV, MD

There are two types of eardrum repair surgeries: myringoplasty and tympanoplasty. Both procedures use a graft to cover the hole, or perforation. Grafts may be composed of tissue taken from the body, such as skin, or they may be paper or gel-like materials. The difference between the procedures is that during a myringoplasty, surgery is limited to the eardrum. Myringoplasty is typically performed for smaller perforations and for conditions in which only the eardrum is affected.

In contrast, tympanoplasty is used for larger perforations. It may also target other areas of the ear to treat infection, remove cysts, or address other issues. Common types of tympanoplasty include:

• Tympanoossiculoplasty, which combines tympanoplasty with ossicular chain reconstruction (ossiculoplasty). The ossicular chain in the middle ear is composed of three bones, called ossicles or middle ear bones, which are responsible for transmitting sound to the inner ear. Ossiculoplasty repairs damaged ossicles to treat or prevent hearing loss.
• Tympanomastoidectomy, which combines tympanoplasty and mastoidectomy. A mastoidectomy removes the bone behind the ear (mastoid), to treat damage or infection.

Depending on the type of eardrum repair, surgery can last for a half hour (myringoplasty) or for several hours (tympanoplasty). The surgeon will make an incision to access the eardrum. Infected tissue and broken bones will be removed, and a graft will be placed to seal the perforation. The ear will heal over four to six weeks. Patients may return home the same day following surgery.

One kind of parathyroid surgery is called bilateral neck exploration. The surgeon finds and looks at all of the parathyroid glands on both sides of the neck, visually identifying any that are diseased and removing them. Minimally invasive, or focused, parathyroidectomy is done to remove a single diseased gland. The gland causing problems is identified before surgery using localization techniques such as hormonal or radiology testing. Since in most cases only one gland is causing problems, focused parathyroidectomy is a common alternative to bilateral neck exploration. Both procedures are safe and effective.

In the rare case that all four glands are diseased, the surgeon will either remove three and a half glands and leave one half in place, or all four will be removed and part of one gland will be transplanted into the forearm. This is done to keep calcium levels where they should be.

After surgery, patients will have a bandage on their neck and a sore throat. Patients may only want liquids or very soft food for the first day, and thy may be asked to take calcium supplements for a while until their remaining parathyroid glands begin functioning well again. Recovery is fairly quick, and within a few days patients should be feeling like themselves again.

Both hypothyroidism and goiters are caused by an autoimmune reaction where the body produces antibodies that attack the thyroid cells for unknown reasons. The thyroid reacts by releasing too little or too much T3 and T4 thyroid hormones, impairing thyroid function and causing irregular metabolism. Goiters develop from the autoimmune reaction causing continued antibody damage to the thyroid over time. Thyroid goiters are large, swollen lumps that can be felt near the base of the neck. Obstructive goiters can cause pain, coughing, and abnormal breathing. Hypothyroidism may also be caused by iodine deficiency, as iodine is needed to produce thyroid hormones.

The exact cause of thyroid cancer and thyroid nodules or cysts is unknown. While thyroid cancer and thyroid nodules or cysts can occur in individuals with thyroid disorders, they are not associated with a malfunctioning thyroid.

Physicians may prescribe thyroid surgery if blood tests reveal patients' thyroid stimulating hormones (TSA) are outside of the acceptable range, indicating a malfunctioning thyroid. Thyroid biopsies (tissue samples) and tests for thyroid-attacking antibodies are also criteria for surgery.

An ENT or general surgeon performs thyroid surgery. While a patient is placed under anesthesia, the surgeon makes an incision at the center of the neck and removes the thyroid gland. Two alternative methods of thyroid surgery are transoral (incision through the mouth) and endoscopic, where a surgeon operates a video camera for live footage to help guide the removal process.

Thyroid surgery requires minimal aftercare. Most patients recover quickly and resume normal activities within a few days of surgery. However, thyroid surgery patients must take daily synthetic thyroid medication (levothyroxine) for life to replace their removed thyroid.