Chronic Ear Surgery in Belgrade: Revision Surgery for Chronic Ear Disease
Updated: 6 days ago
Tympanoplasty is the operation that closes a perforated eardrum and repairs the hearing mechanism behind it. Chronic ear surgery is the wider group of procedures that treat long-standing disease of the eardrum, middle ear and mastoid, including revision surgery after an earlier operation has failed. Both are performed at AF Medico Belgrade by Prof. Dr. Andrew J. Fishman.
If you have had one or more ear operations that did not resolve your condition, this article was written for you.
When previous ear surgery has not resolved your condition
Prof. Dr. Andrew J. Fishman is a specialist in otology, neurotology and cranial base surgery. At AF Medico Belgrade he evaluates and operates across the full range of chronic ear disease: tympanoplasty, tympanic membrane reconstruction, and the surgical treatment of chronic middle ear and mastoid disease.
A substantial part of his practice is revision surgery, for patients who have already had one, two or more ear operations and still have the problem that first sent them to theatre. If you have been told that nothing further can be done for your ear, a specialist reassessment may identify options that have not yet been considered — see when a second opinion before ear surgery makes sense.
What conditions are treated by chronic ear surgery?
Chronic ear surgery covers conditions of the eardrum, middle ear and mastoid. Cholesteatoma needs a different surgical approach and is dealt with separately.
Chronic tympanic membrane perforations — central, marginal, subtotal, or total loss of the eardrum
Tympanic membrane reconstruction, including Total Tympanic Membrane Reconstruction (TTMR) for complete eardrum loss
Chronic suppurative otitis media — persistent middle ear infection with ongoing discharge
Ossicular chain disruption — discontinuity, erosion or fixation of the malleus, incus or stapes
Tympanosclerosis — calcification and fibrous scarring of middle ear structures impairing sound conduction
Chronic mastoiditis and chronic mastoid disease
Adhesive otitis media and tympanic retraction pockets
Injury resulting from previous ear surgery
Traumatic eardrum perforation or post-traumatic ossicular disruption
Conductive and mixed hearing loss caused by any of the above
Hearing implant candidacy — bone-anchored hearing aids (BAHA), active middle ear implants and cochlear implants
Chronic ear disease in children, which needs age-specific surgical planning
Hearing loss caused by fixation of the stapes is a separate condition with its own treatment path — see otosclerosis treatment options explained.
Who is a candidate for chronic ear surgery?
Prof. Dr. Fishman assesses each patient with clinical examination, calibrated audiometry and high-resolution CT imaging of the temporal bone. Surgical evaluation is usually worthwhile for patients with:
A tympanic membrane perforation that has not healed on its own within three months
Recurrent or persistent ear discharge that has not responded to medical treatment
Conductive hearing loss attributed to middle ear disease on audiometry and imaging
A history of one or more previous tympanoplasty or mastoid operations without lasting resolution
Complete or near-complete loss of the tympanic membrane
Ossicular chain damage seen on imaging or at operation
Chronic ear disease in children affecting speech, language development or school performance
Hearing loss in patients who are not suitable for conventional hearing aids
In suitable candidates the goals are a dry, infection-free ear, a healed or reconstructed eardrum, and measurable improvement in hearing. If you are not sure whether your symptoms warrant assessment, see when you should see a specialist for ear, hearing or balance problems.
The surgical approach at AF Medico Belgrade
The TTMR technique
Prof. Dr. Fishman developed Total Tympanic Membrane Reconstruction (TTMR) for patients with no usable remaining eardrum: complete loss, repeated failed repairs, or defects too large for standard grafting. The technique uses:
An extreme lateral anterior surgical approach
Complete removal of the annular ligament
Silicone stenting to hold the middle ear space open during healing
Split-thickness skin grafting
Either autologous temporalis fascia or AlloDerm dermal allograft, chosen case by case
The technique was published in June 2005 in Otolaryngology–Head and Neck Surgery as Total tympanic membrane reconstruction: AlloDerm versus temporalis fascia (Fishman AJ, Marrinan MS, Huang TC, Kanowitz SJ; 132(6):906–915), and was selected for the Mosby Yearbook of Otolaryngology, Head and Neck Surgery 2006. In that published series of 50 patients operated between 1999 and 2004, the overall perforation closure rate was 92%. There was no significant difference in closure rate between AlloDerm and temporalis fascia, and healing time was significantly shorter with AlloDerm.
Microsurgical precision with continuous facial nerve monitoring
Every chronic ear operation is performed under high-magnification operating microscopy, typically 10× to 25×, with continuous electrophysiological facial nerve monitoring throughout. The facial nerve runs through the surgical field of every mastoid and middle ear operation, separated from instruments by less than a millimetre of bone in places. Prof. Dr. Fishman has published and lectured internationally on facial nerve electrophysiology, and applies that work in every operative case.
The surgical toolkit
The operating room at AF Medico Belgrade is equipped for complex chronic ear surgery:
High-magnification operating microscope and endoscopes for access through narrow anatomical corridors
Continuous intraoperative facial nerve monitoring
Surgical lasers for precise tissue dissection and ossicular work
Ossicular replacement prostheses (PORPs and TORPs) in titanium, hydroxyapatite and biocompatible synthetic materials
Autograft materials — temporalis fascia, tragal and conchal cartilage, and remodelled native ossicles
AlloDerm dermal allograft and synthetic substitutes for complex reconstructions
Silicone sheeting and stenting to shape the middle ear during healing
Powered surgical drills, including systems Prof. Dr. Fishman has contributed to through industry consultation
Hearing implant systems — BAHA, active middle ear implants and cochlear implants, where conventional reconstruction is not achievable
Recovery from chronic ear surgery
Recovery from tympanoplasty and tympanic membrane reconstruction is generally more straightforward than most patients expect:
Return to office work: usually within 1–2 weeks
Incisions: placed behind the ear or entirely within the ear canal, with minimal visible scarring
Hearing in early recovery: muffled for the first few weeks while absorbable packing dissolves
Eardrum healing: 8–12 weeks in successful reconstructions
Final hearing test: usually at 3–6 months
The quality of recovery is largely decided before the operation starts, by how thoroughly the problem has been worked up and how precisely the operation addresses it.
Why Prof. Dr. Andrew J. Fishman
Developer of the TTMR technique, published in Otolaryngology–Head and Neck Surgery in 2005 and selected for the Mosby Yearbook 2006
Author of chapters in the Encyclopedia of Otolaryngology on tympanoplasty, tympanic membrane surgery and zone-based perforation analysis
International lecturer and surgical educator — surgeons from several countries have trained with him in these techniques
Industry consultant on the design of surgical drills, nerve monitoring systems, middle ear implants and cochlear implant systems
Extensive experience in revision surgery, after one, two or more previous failed ear operations
His wider practice includes skull base surgery and cochlear implantation. More about his training and career is in his professional profile.
Frequently asked questions
Can a perforated eardrum heal on its own?
Often, yes. Most small, recent perforations close by themselves within about three months. A perforation still open after three months, or one with ongoing discharge or hearing loss, is unlikely to heal without surgery and should be assessed.
I have already had two failed ear surgeries. Is another operation realistic?
Yes. Previous failed surgery does not by itself rule out a good result. What matters is whether the earlier operations addressed the underlying problem, and what the current anatomy allows. Many patients with several previous failures are suitable candidates for revision surgery when the right technique and instrumentation are used.
My eardrum was described as completely destroyed. Can it be reconstructed?
In suitable patients, yes. Complete loss of the eardrum is the exact situation TTMR was designed for. In the published series of patients with no usable remaining eardrum, the overall closure rate was 92%. Candidacy is assessed individually.
How long does the operation take, and will I need a general anaesthetic?
A straightforward tympanoplasty usually takes 60–90 minutes. Complex revision surgery, or combined mastoid and middle ear reconstruction, may take 2–4 hours or more. Most operations are performed under general anaesthesia.
How much does chronic ear surgery cost in Belgrade?
Fees depend on which procedure is needed and how complex it is, so the clinic quotes them once your case has been reviewed. Call AF Medico Belgrade on +381 60 140 67 57 or send your records through the contact form for a quote.
What should I ask before agreeing to chronic ear surgery?
Prof. Dr. Fishman suggests asking any surgeon the following:
What exactly is wrong with my ear, and what is the precise surgical plan?
Will the operation be done under an operating microscope with continuous facial nerve monitoring?
What is your own closure rate for tympanic membrane reconstruction in cases like mine?
If I have had failed surgery before, what in your approach addresses why it failed?
If the disease turns out to be more extensive than expected during the operation, do you have the experience and instruments to deal with it without referring me on?
A surgeon who can answer each of these specifically, based on your own examination and imaging, is the one to trust with the operation.
Does Prof. Dr. Fishman see international patients in Belgrade?
Yes. AF Medico Belgrade regularly treats patients from across Europe and further afield, and the team can arrange review of imaging before you travel, scheduling, and perioperative logistics. An online consultation is also possible for an initial opinion.
Book a consultation at AF Medico Belgrade
If you are living with chronic ear disease — a persistent perforation, recurrent infection, conductive hearing loss, or the consequences of an ear operation that did not achieve what you needed — Prof. Dr. Fishman will review your records and imaging and give you a clear assessment of what is still possible.
Consultations: +381 60 140 67 57
AF Medico Belgrade, Vodice 35, 11090 Belgrade, Serbia
You can also request a consultation through the contact form at www.andrewfishmanmd.com.
This article is for information only and is not a substitute for individual medical examination, diagnosis or treatment.
