Tympanoplasty

What is a Tympanoplasty?

Tympanoplasty is an operation used to repair a hole or tear in the eardrum (tympanic membrane). 

Ear infections, grommet surgery, or trauma can all cause sufficient damage to your eardrum or middle ear bones that must then be corrected with surgery. 

T1 - Tympanic perforation

T1 - Tympanic perforation

The most obvious symptom of a perforated eardrum is that your child’s hearing will be affected. The extent of hearing loss will depend on the size of the hole. As well as hearing loss, you may also notice the following symptoms:

  • earache
  • recurrent discharge of mucus from the ear
  • ear infections - the tympanic membrane acts as a barrier to bacteria, so when it is compromised it can increase the chances of infection

Tympanoplasty is successful in 80-90% of cases. In most cases, the operation relieves pain and infection symptoms completely, while sustained hearing loss is minor.

How do you perform a tympanoplasty?

The operation involves placing a graft under the hole or tear to provide a scaffold for the edges of the perforation to heal over. The graft material is usually taken from beneath the skin behind the ear - an area called the temporalis fascia.

Depending on the severity of the damage, there are two approaches to the operation: either through the ear canal (endaural - T2) or from behind the ear (postaural - T3).

T2 - Edaural approach & T3 - Postaural approach

T2 - Edaural approach & T3 - Postaural approach

A flap of ear canal skin is elevated with the tympanic membrane to allow access to the middle ear (T4).

T4 - Tympanomeatal flap raised

T4 - Tympanomeatal flap raised

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).

T5 - Placing the graft as underlay & T6 - Graft in place

T5 - Placing the graft as underlay & T6 - Graft in place

Once the graft is in place, the ear is packed with a dressing (T7).

T7 - Dressing in canal

T7 - Dressing in canal

If the three tiny bones of your middle ear (ossicles) have been damaged by ear infections or trauma, reconstruction of these (ossiculoplasty) can be performed at the same time. 

The operation usually takes about an hour, and may be performed as a day case or one night stay.

FAQs

What should I expect after the operation?

There may be some pain initially which is easily controlled by simple analgesia such as paracetamol. The ear may feel blocked for a few weeks. This is due to the dressing as well as any fluid accumulation in the middle ear.

Your child may also experience serious discharge from the ear for the first 2 weeks.

A head bandage may be applied after the operation to prevent haematoma formation, which is removed after a day. The dressing, however, may remain in place for 1-2 weeks, after which it can be removed in the clinic along with skin sutures (if used). 

After the dressing is removed antibiotic drops are prescribed for 2 weeks.

The graft can take up to 6 weeks to heal, so the hearing test to gauge the operations success is not performed until after this period has elapsed.

Are there any complications? 

Complications from this specific type of surgery are rare, but can include: 

  • tinnitus
  • dizziness
  • risk of a deterioration in hearing
  • damage to the nerve controlling taste - leading to a metallic taste on that side of the tongue, which usually dissipates after 4-6 weeks
  • damage to your facial nerve has been reported but is extremely unusual

How long before my child can return to school?

Children may return to school 1-2 weeks after the operation.

What will my child’s ear look like afterwards?

This will depend on what approach we took:

  • endaural incision - there is no change to the ears appearance, but a small scar will be visible
  • postaural incision - the ear may stick out initially due to swelling, but will return to its normal position within a few weeks. In this approach the scar is behind the ear and, therefore, not visible.

Can my child swim after the operation?

It is necessary to wait until the graft has taken fully, so it is recommended to wait 6-8 weeks before swimming.

When would my child be able to fly?

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