Hole in ear drum

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.