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Dry perforations of the drum


Surgery to reconstruct the tympanic membrane  (eardrum) can be performed either under local with intravenous sedation or general anesthesia. Many patients prefer to be completely asleep.

Operative Steps:

An incision is made into the ear canal and the remaining eardrum is elevated away from the bony ear canal and lifted forward.

The operating microscope helps to magnify the view of the ear structures, giving a more detailed image to the ear surgeon. If the perforation is very large or the hole is far forward and away from the view of the surgeon, it may be necessary to perform an incision behind the ear. This elevates the entire outer ear forward, gaining access to the perforation. Once the hole is exposed fully, the perforated remnant is rotated forward, and the bones of hearing are inspected. There may be scar tissue and bands surrounding the bones of hearing. These can be removed either with micro hooks or laser.

Having identified the bones of hearing, the ossicular chain is pressed to determine if the chain is mobile and functioning. If the chain is mobile, then the remaining surgery concentrates on repairing the drum defect.

Tissue (graft) is taken either from  the small cartilaginous lobe of skin in front the ear called the tragus or from the coating of a muscle immediately above the ear. The tissues are thinned and dried. An absorbable  under the drum to allow for support of the graft. The graft is then inserted underneath the remaining drum remnant and the drum remnant is folded back onto the perforation to provide closure. 

More gelatin sponge is generally placed against the top of the graft to support it,  hold it into position and prevent it from sliding out of the ear, when the patient blows his nose or sneezes.

If opened from behind, the ear is then stitched together.  A sterile patch is placed on the outside of the ear canal and the patient returns to the recovery room. Generally, the patient can return home within a few hours. Antibiotics are given along with a mild pain reliever such as Paracetamol.

Postoperative Events:

After 7 days, the stitches are removed. Gelfoam packing is removed after two weeks and a good evaluation can then be obtained as to whether the graft was successful. Water is kept away from the ear and blowing of the nose is discouraged. If there are allegies or a cold, further antibiotics and decongestant should be given. Most individuals can return to work after one to two weeks unless they perform heavy physical labor, in which case the patient can return after three weeks.

After three weeks, all packing is completely removed under the operating microscope in the office. It can then be determined whether the graft has fully taken. In over 98 percent of cases, the tympanoplasty procedure is successful and a hearing test is performed at six  to eight weeks after the operation.

Failure of tympanoplasty can occur either from an immediate infection during the healing period, from water getting into the ear, or from displacement of the graft after surgery. Most patients 98% can expect a full "take" of the grafted eardrum and improvement in hearing. After two to three months, water can be allowed to enter the ear and the patient can even return to swimming.

Possible Complications:  

Postoperative dizziness and imbalance can be present for about a week after surgery and are usually very mild. Dizziness is uncommon in operations that only involve the eardrum itself. It is more common if the ear bones has to be repaired or manipulated. Generally, all imbalance and dizziness will be resolved after a week or two.

Besides failure of the graft, there may be further hearing loss due to unexplained factors during the healing process. This occurs in less than one percent of individuals undergoing the operation.. A total hearing loss from tympanoplasty surgery is extremely rare. 

Tinnitus or noises in the ear, particularly an echo-type feeling, may be present as a result of the perforation itself. Usually, with improvement in hearing and closure of the eardrum, these sensations clear up. However, tinnitus is unpredictable. In some cases, it can temporarily worsen after the operation. There is no explanation for this temporary situation, but it is rare for the tinnitus to be permanently worse after surgery.

A small nerve goes through the ear called the chorda tympani nerve. This nerve goes to the taste buds of the tongue. Should this nerve be stretched or cut during tympanoplasty surgery, there may be a transient period of one or two months after surgery where there is a slight metallic or salty taste to food. Generally, the nerve connections will regenerate and taste will return to normal. The abnormal taste sensation rarely lasts longer than six months.