Repair of a perforated ear drum

Tympanoplasty

Tympanoplasty is the  operation  to repair a hole in the eardrum (tympanic membrane). 

Middle Ear infections, grommet surgery and  trauma can all cause a perforation of the ear drum. If the hole does not close by itself then surgery to close the hole can be offered. 

 T1 - Tympanic perforation

T1 - Tympanic perforation

The most common symptom of a perforated eardrum is a leaking ear.This happens mostly because of contamination of  the middle ear which is normally enclosed and  a sterile environment .

Other symptoms include a hearing loss which is more unusual and depends on the size of the perforation

Tympanoplasty is successful in 80-90% of cases. 

 

How do you perform a tympanoplasty?

The operation involves placing a graft under the perforation which  provides a scaffold for the edges of the perforation to heal over. The cells of the ear drum migrate. The graft material is a thin sheet, usually taken from beneath the skin behind the ear - an area called the temporalis fascia.

Our preference is to perform the surgery through an incision behind the ear. Whilst there is a scar this is hidden behind the ear athat usually heals very well nd not very noticeable.

 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 migrate over the graft (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 resorbable 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?

Pain

There may be some discomfort 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.

Discharge

Some discharge from the ear for the first 1- 2 weeks.

 

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

The graft can take up to 6 weeks to heal, and a hearing test is performed then to confirm that the graft is intact and that there has been no deterioration in the hearing

Are there any complications? 

Complications from tympanoplasty are rare, but can include: 

  • damage to the nerve controlling taste - leading to a metallic taste on that side of the tongue, which usually dissipates after 3-4 months
  • tinnitus
  • dizziness
  • risk of a deterioration in hearing
  • The ear may stick out and feel numb for a few weeks

How long before my child can return to school?

Children may return to school 1 week after the operation.

What will my child’s ear look like afterwards?

This will depend on what approach we took:

 

  • 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, which is at least 4 weeks after the surgery

When will 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. and it is recommended that flying be postponed until 4 weeks after surgery.