Tympanoplasty

Overview

Tympanoplasty is a surgical procedure aimed at repairing ruptured eardrums, medically known as tympanic membrane perforations. The eardrum, or tympanic membrane, acts as a barrier between the ear canal and the middle ear. When a rupture occurs, it creates a hole in this membrane, disrupting its ability to vibrate properly and potentially leading to hearing impairment.

Initially, ruptured eardrums are often treated with ear drops or antibiotics by healthcare providers. However, if the eardrum fails to heal within two to three months, tympanoplasty surgery may be recommended to prevent complications such as hearing loss, recurring infections, and balance issues.

During tympanoplasty, surgeons access the eardrum and carefully patch the perforation. Studies indicate that tympanoplasty is successful in treating ruptured eardrums in approximately 93% of individuals who undergo the procedure.

Types

Tympanoplasties repair ruptured eardrums, with techniques varying based on how the middle ear is accessed:

• Postauricular: An incision is made behind the outer ear.
• Endaural: An incision is made above the ear canal.
• Transcanal: Access is through the ear canal, suitable for small holes at the back of the eardrum.

Reasons for undergoing the procedure

A ruptured eardrum that does not heal on its own may require a tympanoplasty. Prolonged hearing loss and ear discharge (otorrhea) are indicators that the eardrum is not improving.

The following conditions could rupture the eardrums:

• Accidentally poked the eardrum while inserting something in the ear such as cotton buds, bobby pin, pencil, or other objects.
• Ear injuries that could caused by head trauma, or loud explosion.
• Eardrums affected by sudden change in the air pressure that cause barotrauma.
• Otitis media or middle ear infection.
• Severe ear infection.

Risk

Complications from tympanoplasty are uncommon. The most frequent risk includes the following:

• Eardrum hole development during surgery
• The hearing worsen.
• Graft failure, which occurs when your eardrum patch fails to correct the issue.

Before the procedure

To determine if tympanoplasty is a suitable treatment for your symptoms, the physician may conduct the following assessments:

• Review of medical history and physical examination.
• Examination of the ear using an otoscope and a microscope for visualizing the eardrum.
• Comprehensive audiometry involving age-appropriate hearing tests.
• Tympanometry, a test measuring the eardrum’s movement in response to pressured air directed into the ear canal.
• Your healthcare provider might prescribe antibiotics to lower the risk of developing an infection, along with potentially shaving the hair around your ear.
• Computerized tomography (CT) scan, particularly if a cholesteatoma is suspected.
• Utilization of a questionnaire to gauge the impact of symptoms on the patient’s quality of life.

During the procedure

Tympanoplasty, a procedure often necessary for repairing eardrum damage, typically requires an operating room and general anesthesia, especially for pediatric patients. Here’s a step-by-step overview of the procedure:

• Anesthesia: The patient is placed under general anesthesia to ensure comfort and stillness during the operation.
• Accessing the ear: The surgeon gains access to the ear either through the ear canal or via an incision behind or in front of the ear. The choice of approach depends on factors like the size and location of the eardrum perforation and the condition of the ossicles.
• Locating the damage: Using either a microscope or an endoscope, the surgeon precisely locates the hole in the eardrum.
• Repairing the eardrum: The surgeon carefully trims away the damaged edges of the hole. Then, a graft—a patch of tissue either from the patient’s own body or a synthetic material—is utilized to close the hole. This graft facilitates the growth of new cells and eventually closes the perforation. Depending on the extent of the damage, the graft may cover only the hole or the entire eardrum.
• Securing the graft: The graft is secured in place with a dissolvable packing material. This packing material aids in stabilizing the graft and eventually dissolves as the eardrum heals and regenerates tissue. The healing process spans several weeks to months.
• Duration of surgery: The duration of the surgery varies based on the complexity of the repair needed. Simple repairs of small eardrum perforations may take only a few minutes, while more intricate procedures involving ossicle reconstruction or mastoid bone removal can last several hours.

This procedure aims to restore the integrity of the eardrum and improve hearing function, ultimately enhancing the patient’s quality of life.

After the procedure

You will probably be discharged to go home after the surgery. However, your healthcare provider may advise you to stay overnight at the hospital for monitoring to ensure there are no complications.

Outcome

Your risk of permanent hearing loss or persistent infection problems is reduced with tympanoplasty. For a few days following your surgery, you can experience mild to moderate pain. Over-the-counter (OTC) pain relievers are typically effective in treating most types of pain.

After tympanoplasty, your recovery period may range from ten days to two weeks. During that period, schedule a bit of relaxation. You will receive instructions from your healthcare provider to follow at home. The following instructions includes:

• If you notice a small amount of blood leaking from your ear, put a cotton ball in it. If you think you are bleeding more than you should, call the healthcare provider.
• For at least three weeks following surgery, avoid blowing your nose. Keep your lips open if you must sneeze.
• Make sure your ear is dry. During the initial days following your surgery, your healthcare provider might advise avoiding taking a shower or washing your hair. A cotton ball dipped in Vaseline should be inserted into your ear when you can take a shower.

Two weeks after surgery, you should see the healthcare provider. They will check the healing of your eardrum by examining it. They might conduct additional hearing exams.

When the pain is under control and they are eating and sleeping well, children who have had a tympanoplasty can resume quiet activities the day of the procedure and go back to their regular activities, including school, three to five days later.

Even though most people recover from surgery without any complications, you should get in touch with your healthcare provider if you experience any of the following:

• Pain has worsen.
• Any foul-smelling fluid that comes out from the ear or at the incision site.