Tympanoplasty

This is a basic surgery performed by ear surgeons to repair a hole in the eardrum. There are several different types of tympanoplasty and the exact one is chosen based on patient age, cause of the hole, location and size of the hole and if previous surgery has been attempted.

Patch Tympanoplasty

This is the most minor of the procedures. It is performed in the office in adults and under anesthesia in children. The edges of the hole are irritated with an instrument, and a biologic tissue paper patch is placed over the hole and held on with a drop of blood from the irritation. It takes a few minutes to perform and causes little pain. The patient then returns to the office in 6 weeks to see if the hole has healed. In the meantime, water must be kept out of the ear and one should avoid heavy exercise and nose blowing

Fat Tympanoplasty

This is another minor procedure that can be performed in the office. The ear lobe is frozen, a small amount of fat is removed, the eardrum is irritated and the fat is placed through the hole. This procedure takes about 15 minutes to perform. The earlobe is sutured.

Medial Tympanoplasty

This is performed in the operating room under local or general anesthesia. It can sometimes be performed working through the ear canal, but is usually performed via an incision behind the ear. Incisions are made in the ear canal and the remnant of the eardrum is lifted up. The ear canal may be widened. A tissue graft from the ear muscle (fascia) or cartilage is obtained and is slid under the eardrum. Packing is placed in the middle ear and ear canal to hold the graft and drum against each other to heal. This procedure takes 1-2 hours to perform.

Central perforation Perforation repaired by medial tympanoplasty

Lateral Tympanoplasty

This is performed under general anesthesia in ears with large holes, holes in the front part of the eardrum or when previous surgeries have failed to close a perforation. It is performed through an incision behind the ear and the ear canal is widened. Some or most of the original eardrum is removed. A fascia graft is harvested, and used to create a new eardrum. A small skin graft is often taken from behind the outer ear and used to line the surface of the widened ear canal to get the ear canal to heal quickly. This procedure takes 2-2.5 hours.

Subtotal Perforation Perforation repaired by lateral tympanoplasty

Complications for Surgery

Pain, infection and bleeding are complications of any surgical procedure. These are fortunately rare in ear surgery. Blood loss after tympanoplasty surgery is usually too small to measure. The ear is numbed with long lasting drugs that generally keep the patient comfortable for many hours. Most patients use Tylenol or Motrin/Advil for pain. Narcotics are occasionally used. Infection after ear surgery is very rare. Antibiotics are used for 1 week after medial and lateral tympanoplasty.

The most common complication is failure of the hole to heal. The frequency of this depends on its size, location, health of the ear and procedure chosen. It can occur in up to 8% of difficult cases. Most patients can then go on to have revision surgery which is usually successful. A second complication is hearing loss. Most patients enjoy improvement of their hearing after successful tympanoplasty but scar tissue formation, Eustachian tube problems and problems with the bones in the middle ear can result in on-going hearing loss. The hearing can rarely be worse after surgery. Conductive, sensorineural or mixed hearing loss may occur. Tinnitus, or ringing in the ear can occur if the hearing worsens.

Taste change can occur after ear surgery due to a nerve of taste that runs under the eardrum and brings taste to the side of the tongue. Loss of taste on the side of the tongue can occur in up to 10% of ear procedures and last for a few months. It can rarely be permanent and is more of a problem in patients who have had surgery in their other ear.

Vertigo and dizziness is common after ear surgery but is usually short-lived and rarely persists. Many medications are given during surgery to prevent nausea and vomiting.

Facial nerve paralysis is a very rare complication of ear surgery. The facial nerve travels through the ear and can rarely be injured during surgery. A facial nerve monitor is used during medial and lateral tympanoplasty which delivers an EMG of the facial nerve to prevent injury.

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