Myringoplasty

Overview

Myringoplasty is a surgical procedure designed to repair a ruptured eardrum (tympanic membrane), which is a thin, dime-sized piece of tissue situated between the middle ear and outer ear. The eardrum plays a crucial role in hearing by vibrating in response to sound waves. Various factors such as ear infections, head trauma, inserting objects into the ear, and sudden loud noises can cause the eardrum to tear or rupture. Myringoplasty aims to mend the hole in the eardrum, thereby reducing the risk of further health complications like vertigo, mastoiditis (an infection of the bone behind the ear), and in severe cases, permanent hearing loss.

This procedure is one of the most commonly performed by otolaryngologists, specialists who treat conditions affecting the ear, nose, and throat. While myringoplasty is more frequently needed in children, adults sometimes require the surgery as well. The surgery is typically performed on just one ear (unilateral myringoplasty), though there are instances where it is necessary to operate on both ears (bilateral myringoplasty).

Myringoplasty not only repairs the damaged eardrum but also helps in preventing the recurrence of ear infections and other complications. By restoring the integrity of the eardrum, the procedure enhances hearing and overall ear health. The success of myringoplasty significantly improves the quality of life for individuals affected by eardrum perforations, offering them relief from the symptoms and risks associated with this condition.

Types

In myringoplasty, various types of grafts may be used, such as:

• Perichondrium: A portion of this tissue may be removed and used to complete the myringoplasty. Perichondrium consists of connective tissue covering the elastic cartilage in the ear.
• Fat: Fat graft myringoplasty repairs the damaged eardrum by using a fat tissue from the earlobe.
• Cartilage: Cartilage myringoplasty repairs the hole in the eardrum using a tiny portion of cartilage.
• Synthetic materials: Paper patch myringoplasty utilizes surgical paper, gel foam, or other synthetic materials to patch a ruptured eardrum.
• Temporalis fascia: A portion of the fascia may be removed and used to complete the myringoplasty. Temporalis fascia is a strong layer of connective tissue over the temporalis muscle.

Reasons for undergoing the procedure

Myringoplasty is a procedure often recommended in specific cases, such as:

• The eardrum has not healed after three months
• A trauma has caused the eardrum to tear
• Hearing loss due to the rupture
• Chronic or recurring ear infections

Myringoplasty can help restore hearing and prevent further complications. Typically, a ruptured eardrum heals on its own within a few weeks.

Risk

As with any procedure, myringoplasty also comes with complications, such as:

• Graft failure, which can manifest as severe bleeding, infection, and altered taste
• Reoccurrence of the hole in the eardrum
• Infection
• Hearing loss
• Tinnitus, or auditory hallucinations
• Lightheadedness

Before the procedure

Before myringoplasty, disclosing all current medications and supplements is recommended. It is also important to plan a time off for recovery and arrange transportation to and from the hospital. Generally, detailed preoperative instructions will be given by the healthcare provider.

During the procedure

Myringoplasty is a surgical procedure that typically lasts between 30 to 90 minutes. It is usually performed under general anesthesia in a hospital, though some people may have it under local anesthesia in a clinic.

Myringoplasty is performed as follows:

• Incision is made behind the ear or via the ear canal to gain access to the eardrum
• Prepare the area surrounding the perforation to facilitate graft attachment by slightly roughening the tissue
• Except if synthetic materials like gel foam are used, obtain tissue from another part of the ear to create a graft, or “patch”
• Position the graft over the perforation in the eardrum
• Fill the ear with cotton packing and apply a bandage to the outer part of the ear

After the procedure

After the procedure, patients receive postoperative instructions and prescribed medications from their healthcare provider to support recovery. Typically, those who received general anesthesia are monitored in a recovery area following the surgery. Most patients are able to return home on the same day.

Outcome

A follow-up check-up is usually scheduled four to six weeks post-surgery. During recovery, it is important to be on look out for potential complications. Seek medical attention if any of these is experienced:

• Persistent and heavy ear bleeding
• Persistent dizziness
• Tinnitus, or ringing in the ears
• Difficulty breathing
• Weakness in facial muscles
• A fever exceeding 103 degrees Fahrenheit
• Persistent ear pain that does not respond to medication
• Intense nausea

The myringoplasty procedure boasts a high success rate of up to 94% for both children and adults. Most patients see improvements in their hearing, and young children benefit from a reduced risk of language delays related to hearing loss. Recovery generally takes one to two weeks, with adults typically requiring at least a week off work and children needing to stay home from school for about a week.