Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Tympanic (eardrum) perforation and myringoplasty

This refers to a condition where there is a hole in the eardrum: myringoplasty is the name of the operation to attempt to reconstruct this.  There may be a hole in the drumhead if there has been significant trauma or middle ear infection, particularly if there is any associated Eustachian tube dysfunction or infection, which can reduce the chance of spontaneous healing.

The principal problem which gives rise to consideration of surgery is recurrent discharge (otorrhoea) due to ear infection.  Sometimes the hole in the ear means that the ear is particularly sensitive to external water.  Perforation may be associated with a conductive hearing loss; hopefully successful surgery would also improve this but cannot be absolutely guaranteed should any small adhesions develop in the middle ear.

The procedure typically involves taking a graft of tissue from the temporalis fascia, which lies just over the temporalis muscle and placing this beneath the freshened edge of the perforation by approaching from inside the eardrum.  This is done by a skin incision either which can be postaural, behind the ear, endaural, just above and in front of the ear or permeatal, in which case the incision into the canal may not be visible externally but just a small incision above and behind the ear where the graft has been taken.  This will be discussed fully with the ENT Surgeon.

There may be a head bandage worn overnight post-operatively and sutures will be removed in around 7 days but it is likely that there will be a small amount of packing left in the external ear canal. This may be a dissolving dressing which clears of its own accord or may be a small dressing which requires removal.  A small amount of a dissolving dressing may be used in the middle ear to support the graft and this will mean that the ear can feel blocked for 2 – 3 weeks afterwards so a degree of patience is needed to await the final outcome.  Avoidance of getting water in the ear is advised, as is vigorous nose blowing or air travel until advised by the ENT Specialist.  Water precautions should also continue to be used for the ear while showering or bathing until these have been deemed unnecessary and 1 – 2 weeks would be recommended off work following the operation.  Mild instability or unsteadiness may occur in the early part of the post-operative period.  A small amount of blood stained ooze may develop in the first 24 to 48 hours after surgery.  Tinnitus, usually mild and transient, can occur post-operatively.

A chance of a successful grafting procedure varies with individual patient conditions but a long-term success rate may be between 70 and 90%.  If successful, this will produce a fully intact drum which should stop the tendency for recurrent ear infections and hopefully, although not absolutely as always mentioned above, improve hearing.  Hence the principal complication is a 10 – 30% risk of graft failure, which will mean that a perforation persists or recurs.  There can be a change in taste on the tongue, particularly with a metallic sensation on the lateral border, if the chorda tympani is bruised, or cut, during surgery.  This often settles spontaneously but occasionally can persist.  There may be transient unsteadiness after the procedure which usually settles and there is a very small risk that the hearing could be worse after the operation.  The ENT Specialist may discuss the minimal possibility of any weakness of the facial nerve; I have personally only seen this once when an inflammation/infection affected the facial nerve and produced a weakness which developed one week after surgery but then fortunately settled fully over the next 3 weeks.

Significant hearing loss is a very rare complication but, with any ear surgery, there is a small risk of deterioration of hearing rather than improvement.