Surgery to close a perforation

Tympanoplasty

Repair of a perforation of the tympanic membrane (T1).
A myringoplasty is the same as a type I tympanoplasty.
A successful outcome is achieved in 80-90% of cases.

Indications

Recurrent discharge
Hearing loss
To enable a patient to swim

Causes of a tympanic perforation

Infection - otitis media
Trauma - direct or barotrauma
Following grommet insertion

How we do it

The operation involves placing a graft under the perforation to provide a scaffold for the edges of the perforation to heal over.
Usually the graft material is taken from the fascia of the temporalis muscle (above and behind the ear).

Approach

Endaural - either through the ear canal (T2)
Postaural - behind the ear (T3)
A flap of ear canal skin is elevated with the tympanic membrane to allow access to the middle ear (T4).
The graft is then placed under the tympanic membrane, covering the perforation. This acts as a scaffold allowing the edges of the perforation to heal over (T5, T6).
Once the graft is in place, the ear is packed with a dressing (T7).
Sometimes reconstruction of the ossicles is performed at the same time (ossiculoplasty).
A head bandage may be applied to prevent haematoma formation.
Operation takes about 1 hour.
May be performed as a day case or one night stay.

What to expect

Head bandage is removed the next day.
May have serous discharge for first 2 weeks.
Dressing may remain in place for 1-2 weeks and then removed in the clinic with skin sutures (if used).
The ear feels blocked for a few weeks. This is in part due to the dressing and any fluid accumulation in the middle ear.
Antibiotic drops are usually applied to the ear for 2 weeks after the dressing is removed.
Graft can take up to 6 weeks to heal.
Hearing test performed 6 weeks after surgery.

Time off work

1-2 weeks

Tympanoplasty

Possible complications

Rare Dizziness
Tinnitus
Risk of deterioration in hearing
Chorda tympani nerve damage - this may lead to a metallic taste on that side of the tongue which usually recovers after 4-6 weeks.
Facial nerve paralysis has been reported but is extremely unusual.

Questions and Answers

Q. Is the operation painful?

A. There may be some pain initially which is easily controlled by simple analgesia such as paracetamol.

Q. What will my ear look like afterwards?

A. With an endaural incision there is no change and only a small scar is visible.
A. With a postaural incision the ear may stick out initially but this returns to its normal position within a few weeks.The scar is behind the ear and therefore not visible.

Q. Can I swim after the operation?

A. Once the graft has taken (6-8 weeks).

Q. When can I fly?

A. Although aircraft cabin pressure is controlled there may be some slight changes which may induce patients to try to pop their ears. This may result in displacement of the graft. It is therefore recommended that flying be postponed until 4 weeks after surgery.