Tympanoplasty

There are many different types of procedures to repair a hole in the eardrum. They are all classified as “tympanoplasty surgery” which means a repair of the tympanum, latin for eardrum. The recommended procedure is based on patient age, cause of the hole, location and size of the hole, patient health 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, or mild acid, and a biologic tissue paper patch is placed over the hole and held on with a drop of blood or ointment. 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 be performed through the ear canal with an endoscope or microscope, or 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 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 approximately 30 to 60 minutes to perform.

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 tissue 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.

Possible Complications

Pain, infection and bleeding are complications of any surgical procedure. These are 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 sometimes 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.

Most patients experience improvement of their hearing after successful tympanoplasty surgery but hearing loss may persist usually due to scar tissue formation or on-going Eustachian tube problems. 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. Vertigo is rare.

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. Vertigo and dizziness are common after ear surgery but is usually short-lived and rarely persistent.

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 decreases the incidence of this complication.