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Eardrum repair

Definition

Eardrum repair refers to one or more surgical procedures that are done to correct a tear or other damage to the eardrum (tympanic membrane).

Ossiculoplasty is the repair of the small bones in the middle ear.

Alternative Names

Myringoplasty; Tympanoplasty; Ossiculoplasty; Ossicular reconstruction; Tympanosclerosis - surgery; Ossicular discontinuity - surgery; Ossicular fixation - surgery

Description

Most patients (and all children) receive general anesthesia. This means they are asleep and pain-free.

The surgeon will make a cut behind the ear or inside the ear canal.

Depending on what needs to be done, the surgeon will:

• Clean out any infection or dead tissue on the eardrum or in the middle ear.
• Patch the eardrum with a piece of the patient's own tissue taken from a vein or muscle sheath (called tympanoplasty). This procedure will usually take 2 - 3 hours.
• Remove, replace, or repair one or more of the three little bones in the middle ear (called ossuculoplasty)
• Repair smaller holes in the eardrum by placing either gel or a special paper over the eardrum (called myringoplasty). This procedure will usually take 10 - 30 minutes.

The surgeon will use an operating microscope to view and repair the eardrum or the small bones.

Why the Procedure Is Performed

The eardrum (tympanic membrane) is between the outer ear and the middle ear. The eardrum vibrates when sound waves strike it. When the eardrum is damaged or has a hole in it, hearing may be reduced and ear infections may be more likely.

Causes of holes or openings in the eardrum include:

• A bad ear infection
• Sticking something inside the ear canal
• Surgery to place ear tubes
• Trauma

If the eardrum has a fairly small hole, myringoplasty may work to close it. Most of the time, your doctor will wait at least 6 weeks after the eardrum developed a hole before suggesting surgery.

Tympanoplasty may be done if:

• The eardrum has a larger hole or opening
• There is a chronic infection in the ear, and antibiotics do not help
• There is a build-up of extra tissue around or behind the eardrum

These same problems can also harm the very small bones (ossicles) that are right behind the eardrum. If this happens, your surgeon may perform an ossiculoplasty.

Risks

Risks for any surgery are:

• Bleeding
• Infection
• Problems breathing
• Reactions to medications

Other risks include:

• Damage to the facial nerve or nerve controlling the sense of taste
• Damage to the small bones in the middle ear, causing hearing loss
• Dizziness or vertigo
• Incomplete healing of the hole in the eardrum
• Worsening of hearing, or, in rare cases, complete loss of hearing

Before the Procedure

Always tell the doctor or nurse:

• What allergies you or your child may have to any medications, latex, tape, or skin cleanser
• What drugs you or your child is taking, including herbs and vitamins you bought without a prescription

On the day of the surgery (for children):

• Your doctor or nurse will tell you if your child should not drink, breast-feed, or eat anything.
• Give your child a small sip of water with any drugs your doctor instructed your child to take.
• Your child's doctor or nurse will tell you when to arrive at the hospital.
• The doctor will make sure your child is healthy enough for surgery. This means your child has no signs of illness or infection. If your child is ill, the surgery may be delayed.

On the day of the surgery (for adults):

• Take only a small sip of water with any drugs your doctor has prescribed.
• Tell your doctor if you have signs of illness or infection.
• You will usually be asked not to drink or eat anything after midnight the night before surgery.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Patients usually leave the hospital the same day as the surgery.

• Packing will be placed in the ear for the first 5 - 7 days.
• Sometimes a fresh dressing covers the ear itself.

Until your doctor or nurse says it is okay:

• Do not allow water to get into the ear. When showering or washing your hair, place cotton in the outer ear and cover it with petroleum jelly. Or, you can wear a shower cap.
• Do not "pop" your ears or blow your nose. If you need to sneeze, do so with your mouth. Draw any mucus in your nose back into your throat.
• Avoid air travel and swimming.

Gently wipe away any ear drainage on the outside of the ear. You may get ear drops the first week. Do not put anything else into the ear.

There are sometimes stitches behind the ear. If they become wet, gently dry the area. Do not rub.

You or your child may feel pulsing, or hear popping, clicking, or other sounds in the ear. The ear may feel full or as if it is filled with liquid. You may notice sharp, shooting pains off and on soon after the surgery.

To avoid catching a cold, stay away from crowded places and people with cold symptoms.

Outlook (Prognosis)

In most cases, the procedure relieves pain and infection symptoms completely. Hearing loss is minor.

The outcome may not be as good if the bones in the middle ear need to be reconstructed, along with the eardrum.

References

Fayad JN, Sheehy JL. Outer surface grafting technique. In: Brackmann D, Shelton C, Arriaga MA, eds. Otologic Surgery. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 9.

Adams ME, El-Kashlan HK. Tympanoplasty and ossiculoplasty. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010: chap 141.