Tympanoplasty, also called eardrum repair, refers to surgery performed to reconstruct a perforated tympanic membrane (eardrum) or the small bones of the middle ear. Eardrum perforation may result from chronic infection or, less commonly, from trauma to the eardrum.
The tympanic membrane of the ear is a three-layer structure. The outer and inner layers consist of epithelium cells. Perforations occur as a result of defects in the middle layer, which contains elastic collagen fibers. Small perforations usually heal spontaneously. However, if the defect is relatively large, or if there is a poor blood supply or an infection during the healing process, spontaneous repair may be hindered. Eardrums may also be perforated as a result of trauma, such as an object in the ear, a slap on the ear, or an explosion.
The purpose of tympanoplasty is to repair the perforated eardrum, and sometimes the middle ear bones (ossicles) that consist of the incus, malleus, and stapes. Tympanic membrane grafting may be required. If needed, grafts are usually taken from a vein or fascia (muscle sheath) tissue on the lobe of the ear. Synthetic materials may be used if patients have had previous surgeries and have limited graft availability.
In the United States, ear disorders leading to hearing loss affect all ages. Over 60% of the population with hearing loss is under the age of 65, although nearly 25% of those above age 65 have a hearing loss that is considered significant. Causes include: birth defect (4.4%), ear infection (12.2%), ear injury (4.9%), damage due to excessive noise levels (33.7%), advanced age (28%), and other problems (16.8%).
There are five basic types of tympanoplasty procedures:
Depending on its type, tympanoplasty can be performed under local or general anesthesia. In small perforations of the eardrum, Type I tympanoplasty can be easily performed under local anesthesia with intravenous sedation. An incision is made into the ear canal and the remaining eardrum is elevated away from the bony ear canal, and lifted forward. The surgeon uses an operating microscope to enlarge the view of the ear structures. 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, providing access to the perforation. Once the hole is fully exposed, the perforated remnant is rotated forward, and the bones of hearing are inspected. If scar tissue is present, it is removed either with micro hooks or laser.
Tissue is then taken either from the back of the ear, the tragus (small cartilaginous lobe of skin in front the ear), or from a vein. The tissues are thinned and dried. An absorbable gelatin sponge is placed under the eardrum to support the graft. The graft is then inserted underneath the remaining eardrum remnant, which is folded back onto the perforation to provide closure. Very thin sheeting is usually placed against the top of the graft to prevent it from sliding out of the ear when the patient sneezes.
If it was opened from behind, the ear is then stitched together. Usually, the stitches are buried in the skin and do not have to be removed later. A sterile patch is placed on the outside of the ear canal and the patient returns to the recovery room .
The examining physician performs a complete physical with diagnostic testing of the ear, which includes an audiogram and history of the hearing loss, as well as any vertigo or facial weakness. A microscopic exam is also performed. Otoscopy is used to assess the mobility of the tympanic membrane and the malleus. A fistula test can be performed if there is a history of dizziness or a marginal perforation of the eardrum.
Preparation for surgery depends upon the type of tympanoplasty. For all procedures, however; blood and urine studies, and hearing tests are conducted prior to surgery.
Generally, the patient can return home within two to three hours. Antibiotics are given, along with a mild pain reliever. After 10 days, the packing is removed and the ear is evaluated to see if the graft was successful. Water is kept away from the ear, and nose blowing is discouraged. If there are allegies or a cold, antibiotics and a decongestant are usually prescribed. Most patients can return to work after five or six days, or two to three weeks if they perform heavy physical labor. After three weeks, all packing is completely removed under the operating microscope. It is then determined whether or not the graft has fully taken.
Post-operative care is also designed to keep the patient comfortable. Infection is generally prevented by soaking the ear canal with antibiotics. To heal, the graft must be kept free from infection, and must not experience shearing forces or excessive tension. Activities that change the tympanic pressure are forbidden, such as sneezing with the mouth shut, using a straw to drink, or heavy nose blowing. A complete hearing test is performed four to six weeks after the operation.
Possible complications include failure of the graft to heal, causing recurrent eardrum perforation; narrowing (stenosis) of the ear canal; scarring or adhesions in the middle ear; perilymph fistula and hearing loss; erosion or extrusion of the prosthesis; dislocation of the prosthesis; and facial nerve injury. Other problems such as recurrence of cholesteatoma, may or may not result from the surgery.
Tinnitus (noises in the ear), particularly echo-type noises, may be present as a result of the perforation itself. Usually, with improvement in hearing and closure of the eardrum, the tinnitus resolves. In some cases, however, it may worsen after the operation. It is rare for the tinnitus to be permanent after surgery.
Tympanoplasty is successful in over 90% of cases. In most cases, the operation relieves pain and infection symptoms completely. Hearing loss is minor.
There can be imbalance and dizziness immediately after this procedure. Dizziness, however, is uncommon in tympanoplasties that only involve the eardrum. Besides failure of the graft, there may be further hearing loss due to unexplained factors during the healing process. This occurs in less than 5% of patients. A total hearing loss from tympanoplasty surgery is rare, occurring in less than 1% of operations. Mild postoperative dizziness and imbalance can persist for about a week after surgery. If the ear becomes infected after surgery, the risk of dizziness increases. Generally, imbalance and dizziness completely disappears after a week or two.
Myringoplasty is another operative procedure used in the reconstruction of a perforation of the tympanic membrane. It is performed when the middle ear space, its mucosa, and the ossicular chain are free of active infection. Unlike tympanoplasty, there is no direct inspection of the middle ear during this procedure.
See also Mastoidectomy .
Fisch, H. and J. May. Tympanoplasty, Mastoidectomy, and Stapes Surgery. New York: Thieme Medical Pub., 1994.
Roland, P. S. Tympanoplasty: Repair of the Tympanic Membrane. Continuing Education Program (American Academy of Otolaryngology-Head and Neck Surgery Foundation). Alexandria, VA: American Academy of Otolaryngology, 1994.
Tos, M. Manual of Middle Ear Surgery: Approaches, Myringoplasty, Ossiculoplasty and Tympanoplasty. New York: Thieme Medical Pub., 1993.
Downey, T. J., A. L. Champeaux, and A. B. Silva. "AlloDerm Tympanoplasty of Tympanic Membrane Perforations." American Journal of Otolaryngology 24 (January/February 2003): 6-13.
Duckert, L. G., K. H. Makielski, and J. Helms. "Prolonged Middle Ear Ventilation with the Cartilage Shield T-tube Tympanoplasty." Otology & Neurotology 24 (March 2003): 153-7.
Oshima, T., Y. Kasuya, Y. Okumura, E. Terazawa, and S. Dohi. "Prevention of Nausea and Vomiting with Tandospirone in Adults after Tympanoplasty." Anesthesia & Analgesia 95 (November 2002): 350-1.
Sheahan, P., T. O'Dwyer, and A. Blayney. "Results of Type 1 Tympanoplasty in Children and Parental Perceptions of Outcome of Surgery." Journal of Laryngology & Otology 116 (June 2002): 430-4.
Uzun, C., M. Velepic, D. Manestar, D. Bonifacic, and T. Braut. "Cartilage Palisade Tympanoplasty, Diving and Eustachian Tube Function." Otology & Neurotology 24 (March 2003): 350-1.
American Academy of Otolaryngology - Head and Neck Surgery. One Prince Street, Alexandria, VA 22314. (703) 806-4444. http://www.entnet.org .
American Hearing Research Foundation. 55 E. Washington St., Suite 2022, Chicago, IL 60602. (312) 726-9670. http://www.american-hearing.org/
"Perforated Ear Drums." Audiology Net. http://www.voice-center.com/tmperf.html .
Tympanoplasty animation. Otolaryngology Houston: http://www.ghorayeb.com/TympanoplastyPictures.html .
"What is Tympanolasty?" PennHealth. http://www.pennhealth.com/health/hi_files/balance/hi13.html .
Monique Laberge, Ph.D.
Tympanoplasty is usually performed on an outpatient basis by an otolaryngologist, a physician specialized in the diagnosis and treatment of disorders and diseases of the ears, nose, and throat. For most adults, Type I tympanoplasty is performed in the office of the otolaryngologist with topical anesthesia at the tympanic membrane site, and subcutaneous local anesthesia injection at the graft donor site. An overnight stay is recommended if the the tympanoplasty involves ossicular replacement.
can i ask you about TORP and PORP technik
Before 6 YEARS MY WRIGHT HEAR IS COMPLETELLY DISTURB MY WIFE ITS hEARING LOSS ITS BLEEDING WE TALK DOCTOR AND HE SAY IT MUST BE SURGICAL TREATMENT I AM FROM ETHIOPIA WHERE AND HOW CAN I TREAT MY EAR.
PLEASE HELP ME SOMETHINGTREAT MY EAR
Sorry to hear that you have had so many problems with your ears.
I too have had countless ear infections since the age of 6 months, tubes put in my ears and 2 tympanoplasty surgeries.
At 48, I just had my last set put in last year. The left fell out 3 months following and the majority of my ear drum has disintegrated. Given the many many ear infections and the possibility of many more due to Eustachian Tube dysfunction, I was told, to do another tympanoplasty would create more infections. My body has disintegrated my ear drum in the attempts to regulate the air pressures without infection. So replacing the eardrum would start the cycle again. I want to be free of many attempts, and forgo the ones that fail.
So, now I am looking forward. Finding the right hearing aids for me, interesting ways to use technology to hear what I love. Aswell, I am looking into finding a stethoscope that I can use with my hearing aids. I am an RN now and love what I'm doing.
Having fun researching new hearing technologies and working out the kinks.
My motto? Never Give Up!!!
We're going for a second opinion as recommend by my doctor but he's beginning to think that I might not be able to handle the pressure in my ear and need the hole reinserted. All I'm saying to all you parents with kids like me who have perferated eardrums/hearing loss I feel like my hearing has gone down in that ear (plus the right still hasn't been fixed) if I'm not paying attention I'll completely miss what people say or if I'm in a loud room I can't hear people talking to me. Be careful with the Tympanoplasty surgery they say that my symptoms that I'm feeling are very rare but they know it's serious because it's gone on for over a year and a half.
My parents pushed for it because they didn't want me to have a hearing aid but now I wish that they would have seen the other side because I'm in more pain than I've ever been in before. I'm not saying not to get the surgery but definitely talk about a hearing aid before you do or if you do get the surgery and your child starts to have these symptoms believe them because it took a long time for me to convince my parents and doctor of what I was feeling.
So far it looks to be holding good.I had the outer packing removed today and have the cotton filled in my ear and held externally by a small bandage.
My next visit to the Doc is after 2 weeks from today when he would remove the cotton and see if the graft has held up or not.
Some of the things that iam experiencing post surgery are.sound in my ear(tick-tick) when i swollow something..constant feeling like a slow wind blowing out of my ear...
Apart from this there is slight drowziness due to the medication that the Doc has prescribed.
As i checked with the Doc today iam still not suppose to take head bath for next 2 weeks until he has checked the ear and seen how the graft has held up.
Some precautions that need to be taken care for 2 to 3 weeks more are
1. No sleeping on the side of the operated ear.
2. No hard nose blowing
3. No weight lifting etc.but less sternes exercises like jogging, running etc can be done.
The surgery itself is not physically difficult on you but the inconvinence of having the ear stapped with bandage and not being able to hear well for sometime is a little inconvinent at most.
To all those who have gone through the surgery and recovering.Get Well Soon!
and to those who have decided to go for the surgery.Best of Luck!
My background: I had a perforated eardrum for over 17 years caused by a careless ENT who had removed a tube in my ear along with 1/3 of the eardrum tissue. I never had any issues until a skiing trip about 15 months ago where a cold turned into a really bad sinus infection that later gave me an ear infection that did not go away. My ear was uncomfortable, inflamed and infected. I saw my ENT specialist every other month with almost no improvement even with the countless use of expensive ear drops and oral anti-biotics. I was given a referral to another ENT Specialist in Los Angeles, they helped with the infection by using a simple and cheap vinegar/water ear swish I would drop into my ear every morning. This helped the inflamation and infection so that my surgeon could finally feel comfortable enough to recommended surgery to repair the perforation.
The risks of this surgery are all over the internet, and the clinics do give you a large list of complications that could arise. I consider myself fortunate that the doctors and nurses were very skilled.
Also, can you get a perforation by have your ears cleaned out? Just say that the Nurse that is flushing the ear out puts too much pressure and suddenly you have excrutiating pain in that ear.
Next thing you know, you have a perforation.
is it ok to undergo operation (again n again). now my doctor again saying to operate also on nose which is regularly block. so may be coz of this blockage pressure is developing on that side of eardrum.
please suggest me should i again perform the operation
really tensed as i may lose my hearing .
He has had recurring ear infections over the years, has had tubes put in his ears twice and now has fluid in his ears with significant hearing loss.
The doctor has suggested a tympanoplasty in one ear that he says has a perforation in it probably from the tubes that were put in his ears.
In the other ear, he wants to put a tube in that one.
The doctor says my son has about 40 decibels of hearing loss and probably won't get hearing completely restored in the ear that will get the tympanoplasty.
But, says that the ear that is getting the tube will probably require repeat operations (tubes) over the years until he just grows out of it.(most of the time in mid to late teens)
My question is: If what i keep hearing is true and tubes can cause the perforations, then why would a doctor knowingly suggest this course of treatment? Almost sounds like reaching a point of diminishing returns..
Can someone please explain to me what other options are out there? It almost sounds like once you get on this carousel, it's never ending..
Frustrated father in Texas.
To all that has had or going to have the Tympanoplastyy Surgery, I wish you the best and rest and do as the doctors say afterwards.God Bless you all.
is it possible for me?
even after the operation.
Im confused as to what has caused the infection? Especially after going (2) times to the doctor within 5 weeks post surgery and there not having been any infection, and now all the sudden there is an infection again? ANY IDEAS TO WHAT THE PROBLEM IS? THANKS
This is because I have fluid inside my ears and they form into bubbles that crackle and pop every single time i open up my mouth causing blockage in my ears that will not unblock unless i sniff.
The ear specialist that i go to say that this is very rare and they have not seen anything like it before, and they are guessing it is caused because the hole in my ear drum is not big enough for fluid to flow out once it gets in.They say they have no other ways to treat it besides continuously inserting grommets into my ears every time they fall out.Besides that they say they could cut open my neck and take the muscle from there and put it into my ear but are not sure that it will be successful and might end up in the same result as the grommets being put in.
Is there any other ways to treat this?
I would be grateful if you could get back to me!
Has anyone had this problem? I would like it to come back! Any craving I have has been left unsatisfied because I eat what I am craving and nothing happens!
28 Male healthy except for my hearing, and now my taste..!
i consulted the doctor who operated me, he said its the "Eustashian Tube Dysfunction"..and he gave me "LAZINE tablets" for cold..today after one year my ear is paining and am very much worried about it.
And the most horrible thing is that am craven for any operation.
Am really frustrated... please help me..
I was looking through this site since I most likely have to get the
surgery again because I got another hole, but this time they want to
use cartilage instead of fascia which is supposed to be more robust.
I stumbled on your comment about having frequent infection,
hearing loss, and drainage with a fetid odor from your ear. It's rare,
but I think you may want to have that checked by an ENT if you havenâ€™t
already to be sure itâ€™s not a cholesteatoma. I had to get my ear checked
for one by CT before I could do the surgery.
t remov ed,my hear ing improved a lot but i started getting a ringing sound and its ther for the last 3 months now.I called up the Ent Surgeon and he says it will 100percent go away.Please advice as the sound is very irritating and loud sometimes..
I would like to say how it is a painless procedure but i'd be lying. It was the worst 3 weeks of my life the pain was unbearable at times and still is, but not very often.
As long as you look after it for example excessive loud noises or swimming too often and keep it clean with ear drops if it gets blocked the chances of complications aren't very high.
Hope this has helped.
She still has pain like constant ear ache and a feeling of her ear being full and is now very dejected at the constant problems over almost six months.
I feel that the issue lies with the Estiun Tube being blocked by fluid but the consultant seems to be using a suck it and see approach which is not helping the concern she has one bit.
If anyone can shed any light on this it would be much appreciated
i m 23 years old now . i have a chronic ear recurrent infection of middle ear with perfiration for the last 15 years that has now fibrotic on the edges with minor mastoiditis . i hve done audiogram which shows eighty percent hearing loss.
the ent specialist has adviced me to do the tympanoplasty for it .
but i am afraid of it prognosis.
would u like me to give the best place or hospital where it can be affordable and well prognosis .
even if the surgery is done in uk ,
i am a medical student studying in pakistan.
plz share with me the detail cost and procedure and prognosis of the tympanopasty .
the issue you are describing here is mastiodious and is a serious condition please find a doc especially ent specialist
I am saqib from Pakistan. I have deafness left ear, ringing, buzzing & have a hole in left ear drum. My Doctor advised me for tympanoplasty surgery. So my question here after the surgery deafness will be completely or not?... can i live normal life same to normal people who hear well or not?...
Can anyone explain me why is it so?
i mean where it was done perfectly
So far I have had my first surgery on my right ear I currently have packing still in my ear and I can't hear out of it yet.. But my sutures and my ear look great. The first 3 days I was sore and still coming off of the Anastasia my ear was very bruised and tender.. But it is tolerable. At times I can hear ringing and the first day I was really dizzy.. Every time I Took a car ride I would get carsick. I was suppose to rest like the first week after surgery but I couldn't I was ready to get up and do things.. But maybe that's just me!? Idk. The part I disliked the most was that they had to shave part of my hair.. But it wasn't too bad it's kinda in style know anyways.. I have another apt on the 9th of June to have the packing removed and make sure that the procedure was successful. So I am hoping for the best. So far though my experience wasn't horrible and it was very tolerable. I am trying to stay focused and positive that it will be successful and I will have 85% better hearing and maybe for once be normal. :)
Dear Zeny #115 seem like you had luck with your surgery. Please give me the advise...Thanks ! (email@example.com)
I am feeling the pressure building up in my ear after the tympanoplasty.
what happened to my ear is it okay ?
ry, or perhaps a second rupture? I'm at a loss and going mad.
months ago. It was very painful and now I have no sense of taste. I still am totally deaf in that ear and my other ear only has about a 10% hearing with a hearing aid. I would not recommend this procedure to anyone!!!
I had a Tymcanoplasty w/epi disc/ fat graft on right ear.. Yeah they made a cut behind my right ear removed fat and cartilage to graft on the very large hole in the small portion of ear drum I have left. I am 50 years old , but i got a really bad infection in my right ear that was categorize as a ear disease when I was around 7 years old it was very pain and the daily oozing stinky drainage was terrible. I had a total of 7 surgery's but by the time they try to put the last tube in, the infection had eaten half of my eardrum and no tubes would fit they just fell out while the were putting them in. So I have dealt with hearing lost pretty much my whole life I can read lips .so I have to face you when you are talking to me so I can see what you are saying more than hear. Now my hearing lost is worsen and my speech has started to change because of your audio flap is on right side so when you lose you hearing in that ear your speech will also get worse and I did not know that but I was glad the lady doings my test explained it to me, didn't make me fell better but its nothing I can do about it. Pluse my doctor said that he was no sure my surgery would be a successful because of my age. If not he would have to do a more avesives procedure.
a lot of pressure in the ear other times there are loud noises Sometimes the ear is reasonably ok The hearing is still damaged as antibiotics were given by the doctor who did not see my perforated ear
Will all these different sensations finally go with time?