What is the surgical repair of a hole in the eardrum?

The eardrum, or tympanic membrane, is located deep within the ear canal. It can sometimes develop a hole in it, known as a tympanic membrane perforation. Causes of tympanic membrane perforations include trauma, either directly from objects like Q tips, or indirect, such as concussive forces from a slap to ear, and infection. The tympanic membrane helps amplify sound, and any defects in it can cause a decrease in hearing. Most tympanic membrane perforations heal on their own over time.  However, if the eardrum does not heal there is a risk of hearing loss and the ear is vulnerable to infections.  Repairing the hole requires the placement of a graft to allow the tympanic membrane to heal.

There are several procedures that can be performed to repair a hole in an ear drum.  The type of surgery depends on the size of the hole, the location on the ear drum, and other parts of your medical history.  A myringoplasty is a surgery where the hole is repaired using a graft made of either a small piece of tissue from elsewhere on the body (typically the earlobe), or a gel-like material.  A tympanoplasty involves a more extensive rebuilding of the ear drum

The goal of surgery is to close the hole in the eardrum and improve hearing. This surgery may be performed for several different reasons (improve hearing, decrease infections, etc)

What to do BEFORE surgery

Here are a few things you can do before surgery to help things go more smoothly:

  • Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon.  Please see this list--Medications to Avoid Prior to Surgery
  • Stop smoking at least 3 weeks before your surgery date.
  • If you/your child gets a chest cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia.
  • Sometimes blood counts and clotting is checked before surgery to make sure you are not at risk of increased bleeding. Labs need to be drawn the week prior to surgery. Your insurance carrier may dictate the lab where the blood is drawn.
  • No food 8 hours prior to surgery.  No liquids for 4 hours prior to surgery.
  • Arrange for a ride home after the procedure

What to Expect During Surgery

Surgery is performed under general anesthesia. With general anesthesia, you (or your child) will be asleep for the entire surgery.  Myringoplasty typically lasts 10-45 minutes.  A tympanoplasty typically takes 1-2 hours.  Both procedures are performed as an outpatient.  Surgery is typically performed directly through your ear canal, although on occasion a tympanoplasty needs to be performed through an incision behind the ear. This depends on your anatomy, as well as the size and location of the hole in the eardrum. During surgery, the edges of the hole are “freshened” to stimulate the body’s own natural healing process.  A graft (either synthetic or taken from the patient’s own ear is placed to close the hole.  Packing is placed underneath the ear drum to hold the patch in place. Ointment may be applied to the ear canal.  A dressing is then placed over the ear.  After surgery the patient is monitored in the recovery area for several hours.

What to expect AFTER surgery

  • Pain associated with the procedure is typically mild.  Most patients can manage their pain with over the counter Tylenol.  Rarely are pain medications prescribed. DO NOT USE ASPIRIN OR IBUPROFEN PRODUCTS FOR 1 WEEK AFTER SURGERY
  • Do not be concerned regarding your hearing during the healing process. It takes 6 - 8 weeks before we can evaluate improvement and your hearing will be tested at that time.
  • Bloody drainage from the ear or incision behind the ear may occur during the first 1-2 days. Call the office if this persists longer than 2 days or if the incision site develops an odor, swelling, or pain.
  • Water should be kept out of the ear until it is healed.  Avoid getting the ear wet for 5 days after surgery.  Use earplugs or a cottonball covered with Vaseline to keep the ear dry when bathing.  Getting the ear wet can cause an infection.
  • Do not blow your nose for 4 weeks.
  • Cough or sneeze with your mouth open.
  • Ear drops should be used as prescribed.
  • No bending, lifting, straining, exercise, or traveling until approved by your surgeon.
  • No flying or changes in altitude until cleared by your surgeon.
  • Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
  • You should have an appointment three (3) weeks after surgery to check your ear.

What are the risks of Surgery?

As with any surgical procedure, repair of the ear drum has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

Continued hole in eardrum: The most common complication is failure of the graft to take hold, with a resultant persistent hole in the eardrum. Tympanoplasty and myringoplasty are highly successful. If failure occurs, consideration might be given for a repeat attempt or different technique at a later date.

Bleeding: Excessive bleeding during this surgery is rare.

Infection: Infection in the operated ear is also rare. If this was to occur, it could potentially cause failure of the eardrum repair.

Hearing loss: Hearing is usually diminished initially after surgery due to packing. It improves as the packing dissolves. It may be several months before you will know your final hearing result.  Permanent hearing loss after this surgery is rare. It is possible that your hearing does not improve after surgery.

Dizziness: Dizziness can occasionally occur after the surgery. This is rare. Most likely dizziness resolves over several days. Permanent dizziness is extremely rare.

Tinnitus (ringing in the ears): Ringing in the ear (tinnitus) can also occur after this surgery usually related to how your hearing changes after the surgery.

Metallic taste: There is a small nerve that runs in the middle ear that controls a portion of your taste on that side of your tongue. This nerve can be stretched or cut during surgery. This would lead to a metallic taste for several weeks. This would typically resolve on its own. You have several other nerves that supply taste, so taste, so you should still be able to taste

Cholesteatoma: There is a small chance that repair of the eardrum could induce a small skin cyst in the eardrum, ear canal or middle ear. This is called a cholesteatoma. If this was to occur, another surgical procedure would be necessary.

Facial weakness: The nerve that controls your facial movement called the facial nerve also runs through the middle ear. Despite the greatest care it is possible to injure this nerve. Although extremely unlikely, injury to this nerve would cause weakness or paralysis of the muscles of one side of your face.

Numbness: If the surgery was approached through an incision behind your ear, it is likely that you will feel numbness in your ear for several weeks to months after surgery. This typically resolves over time.

Change in appearance of ear: If surgery is done through an incision behind your ear, you may also notice some protrusion of your ear after surgery. This typically settles down after a few weeks.

Anesthesia Risks: As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even death are possible. Please discuss these risks with your anesthesiologist.

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