What is a Tympanoplasty?

Hole in the Ear Drum

The Tympanic Membrane (Eardrum). Photo © A.D.A.M.

A tympanoplasty is a surgical procedure generally used to repair a ruptured ear drum but sometimes involves the repair of the tiny bones in the inner ear.

What Causes a Ruptured Ear Drum?

A ruptured ear drum can be caused by an ear infection, barotrauma or injuries to the ear. During a tympanoplasty, the ear drum is repaired using a tissue graft, often made of adipose (fat) tissue.

There are several different types of tympanoplasty and the exact one is chosen based on various factors including the age of the patient, what caused the hole, the location and size of the hole and whether or not any 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. It takes a few minutes to perform and causes little pain. The patient returns to the doctor in about six weeks to see if the hole has healed. 

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 through 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 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 one to two hours.

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 about two hours.

Complications for Surgery

Pain, infection and bleeding are rare in ear surgery. Most patients use over-the-counter pain medicine for pain. Antibiotics are used for one week after medial and lateral tympanoplasty.

The most common complication is failure of the hole to heal. 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 ongoing hearing loss. 

Vertigo and dizziness is common after ear surgery but is usually short-lasting.

 

Before and After Surgery

 

Before surgery, you will probably be instructed to keep water out of your ears. A tympanoplasty is usually performed as an outpatient procedure, meaning you can go home the same day you have surgery. After surgery you should avoid blowing your nose, keep your mouth open when you sneeze, keep water out of your ears and avoid lifting anything over 10 pounds. Depending on how extensive the tympanoplasty is and the method used during surgery, a tympanoplasty can take weeks to months to heal. Approximately 2 to 3 months after the surgery, you should have a hearing test. Tympanoplasty is considered more successful in adults than children.

Continue Reading