This article is about myringoplasty and tympanoplasty, operations performed on the middle ear. This resource is open to everyone. Patients, Medical Students and Medical Professionals may find this useful. Adjacent boxes provide additional information for Medical Professionals.

 

What is Myringoplasty and tympanoplasty?

Myringoplasty is the name for surgery to repair a hole (perforation) in the ear drum.
Tympanoplasty is a broader term including surgery to repair a hole in the ear drum with or without reconstruction of the hearing bones.

There are many different ways to repair a hole in the ear drum. Most often a small piece of temporalis fascia (the fibrous covering over a muscle behind the ear), fat, or cartilage from the pinna (external ear) is used to fill the perforation. This is called a graft. The graft acts like a scaffold, allowing the ear drum to regrow. Sometimes dissolving artificial material is used instead, such as a paper-patch or gel foam.

Tympanoplasty involves checking the hearing bones (ossicles) and may also involve removing parts of the hearing bones if they are diseased. Hearing may be restored using cartilage or other body tissues, or artificial middle ear implants.

Both myringoplasty and tympanoplasty may be done by making an incision behind the ear, at the front of the ear, or by operating through the ear canal.

Types of tympanoplasty

Type I – myringoplasty with inspection of the ossicular chain

Type II – repair of the eardrum with grafting onto the incus or remnant of the malleus

Type III – grafting onto the stapes suprastructure

Type IV – grafting onto the stapes footplate

Type V – grafting onto a fenestration in the horizontal semi-circular canal

 

What are the indications?

Myringoplasty is performed to repair a chronic perforation of the ear drum that has not healed with time and non-operative treatments. Many people with an ear drum perforation will have hearing loss, and some will suffer from repeated infections or discharge (fluid leaking) from the ear due to the perforation. The aims of myringoplasty are to improve hearing, prevent infections, and give patients a dry ear.

Children and adults can have chronic ear drum perforations. In general myringoplasty is not done on children until they are old enough to keep their ear dry and free from infection, and to follow recovery instructions after surgery.

Tympanoplasty is performed for a variety of middle ear abnormalities including chronic perforation of the ear drum, erosion or disease of the ossicles (hearing bones) and cholesteatoma limited to the middle ear (see cholesteatoma) – . Sometimes tympanoplasty is performed at the same time as surgery on the mastoid bone for cholesteatoma that has grown beyond the middle ear (see mastoidectomy)

 

What happens before surgery?

Before having surgery the ear needs to be free of infection. Patients will be assessed by an Otolaryngologist and have a baseline hearing test with an Audiologist.
The Otolaryngologist will talk about the risks and benefits of surgery, and the patient will be able to ask questions and decide if they wish to have surgery.

In the lead up to surgery patients are often asked to keep their ear as dry as possible to make sure there is no infection at the time of surgery.

 

How long is the surgery?

There are many different ways to repair a hole in the ear drum. The length of surgery depends on the method chosen and may take between 30 minutes for a simple repair to 3 hours for a complex repair with hearing reconstruction.

 

What are the risks?

The main risk of surgery is failure of the repair. This can happen due to infection or movement of the graft after surgery. Success rates for closure of the perforation are between 70-90% depending on the size and location of the perforation, as well as other patient factors. Large perforations that involve most of the ear drum have a lower chance of successful repair.

After surgery it is very important to keep the ear dry and avoid pressure changes in the ears to give the best chance of success. Physical exertion, heavy exercise, heavy lifting, straining and nose blowing should be avoided.

Other risks of surgery include:

  • Bleeding
  • Pain
  • Infection
  • Change in taste (temporary)
  • Poor hearing improvement or worsening of hearing
  • Tinnitus (ringing in the ears)
  • Scarring
  • Other risks of surgery and anaesthesia, e.g. blood clots and allergic reaction

 

Are there alternative options?

Surgery is done to improve quality of life. Alternative options include using a hearing aid to improve hearing and avoiding water getting into the ears to reduce ear infections and ear discharge.

 

How long is the recovery?

Patients may go home the same day of surgery or stay in hospital overnight. Sometimes a head bandage will be kept on overnight to help prevent bleeding. Almost all patients who stay overnight are able to go home the next day.

Most patients will need time off work or school. The length of recovery depends on the type of surgery performed. Most patients will be able to do their normal day to day activities within a few days of surgery, however sports and heavy duties at work should be avoided for at least a few weeks after surgery. It takes around 6 weeks for healing of the ear drum repair and surgical incisions, although in some cases there may be restrictions for up to 3 months. The ear should be kept as dry as possible until it has fully healed.

Further reading:

See pages on ear anatomy and perforation of the tympanic membrane for more information.

 

References:

 

Author + Affiliation:
Dr Rachael Bentall, Department of Otolaryngology, Waikato Hospital

Date of Publication +/- Review:

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Myringoplasty and tympanoplasty

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