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Tympanoplasty Ear Drum Perforation PATIENT INFORMATION

Tympanoplasty literally means reconstruction of the inner ear. "Tympano" is Latin for drum, thus the ear drum. "Plasty" means reconstruction or plastic to form. Tympanoplasty can entail many different procedures. Sometimes tympanoplasty is as simple as repairing a small hole in the ear drum or as complicated as reconstructing the whole hearing mechanism including the ear drum and the ear bones. The most simple type of tympanoplasty involves repair of the ear drum. A tympanic membrane perforation or hole in the ear drum can result from chronic infections, placement of a tube in the ear drum, or trauma to the ear drum. Sometimes the hole in the ear drum will close on its own. Small perforations can be repaired with techniques on the outside of the ear drum. This type of repair is known as a myringoplasty. The myringoplasty differs from the tympanoplasty in that the procedure is relegated to dealing outside of the ear drum. This can be accomplished using a small paper patch, gelatin film, or sometimes a piece of fat. Often this procedure is done with a local or topical anesthetic.

Tympanoplasty involves repairing the ear drum by lifting up the ear drum. There are two major types of tympanoplasty for repairing the ear drum. The most common type is the underlay technique in which the tissue used to repair the ear drum is placed under the ear drum. The most common material used for this is fascia or the covering of the muscle. The temporalis muscle is a chewing muscle that lies right at the ear. This is the most commonly used tissue. Other tissue used can be the covering of the cartilage called the pericondrium. The underlay technique can be done via an incision in the crease behind the ear or an incision in the ear canal. For small perforations located in the back portion of the ear drum, an incision in the ear canal suffices. However, for extensive ear drum repairs, it is necessary to make an incision in the crease behind the ear.

The second type of technique used is called the overlay technique. In this procedure, an incision is made behind the ear and the skin of the ear canal removed. The ear canal is then drilled away in order to visualize the entire ear drum. The graft for the new ear drum is then placed on the outside of the ear drum and then the skin replaced. This is a more extensive procedure but is necessary in cases of extensive disease in the ear canal and when the perforation is located in the very front part of the ear canal with the large bulge in the ear canal. The patient does not notice the difference one way or the other with these techniques.

Many times it is necessary to repair one of the three ear bones in the middle ear in tympanoplasty. These bones can be injured from a cyst known as a cholesteatoma which is a skin cyst that usually forms from chronic Eustachian tube dysfunction. The cyst can eat away the tiny ear bones. Trauma to the ear can also cause injury to the ear bones and necessitate repair of the ear bones. Sometimes chronic infections can also lead to destruction of the ear bones. Most commonly the incus or anvil is the ear bone involved with these processes. The incus can usually be replaced with many materials including cartilage or you can refashion the incus into a different shape and reposition it. The most commonly used device to reconstruct incus erosion is an artificial bone made of titanium. When the top part of the third ear bone or stapes remains a partial ossicular replacement prosthesis known as a PORP is used. When the top part of the third ear bone is gone a total ossicular replacement prosthesis or TORP is used. See Diagram I.
In these cases a piece of cartilage obtained from the tragus, or the stiff portion just in front of the ear, is used to place over the prosthesis to prevent extrusion. (Diagram I)

What to Expect
Most cases of tympanoplasty are done with a general anesthetic so the patient is asleep. However, this can be done with a local anesthetic or numbing the ear. If an incision is necessary behind the ear, a large wrap bandage around the head will be placed at the time of surgery .This can be taken off the next day. If the incision is made in the ear canal a cotton ball will be placed in the ear with a band aid. Almost all tympanoplasty surgeries are done as outpatient. It is very rare that the patient requires an overnight hospitalization. There will be some discomfort and soreness in the ear but this is usually not severe. Minor analgesics are usually all that is necessary. However, narcotics are usually provided in the immediate post operative course as necessary. You will also be given an antibiotic to prevent infection in the immediate post operative period as well. It is important that one not take any aspirin, Advil, Nuprin, Aleve, or any of these types of medicines prior to the operation for seven days as they cause bleeding. Tylenol is fine as it does not cause any bleeding. The day after the surgery a call will be made to check on the patient. The patient then returns to see Dr. House or the referring physician one week after surgery to check the wound and make sure things are healing well there. The packing of gelatin sponge inside the ear canal will not be disturbed at that time. Two weeks after surgery drops that will be prescribed will be placed in the ear canal to help dissolve the packing in the ear canal. On a second visit approximately six weeks after surgery I the remainder of the packing in the ear canal will be removed. About ten weeks after surgery, the packing that is on the inside of the ear drum will start dissolving and the hearing generally starts improving at that time. Maximum hearing gain can usually be expected within about four months. It is important to care for the ear properly in the post operative period. Do not get the ear wet in the first week after surgery .After that, it is okay to wash behind the ear and get the area behind the ear wet. However, water should still not go in the ear canal for six weeks. When washing the hair, it is important to place a cotton ball in the ear canal with tape or Vaseline over the cotton ball. DO NOT USE AN EAR PLUG. This ear plug can press all the gelatin sponge down and dislodge an ear bone or the ear drum. At the end of six weeks, on your return visit you will be notified as to the status of swimming and getting water in the ear.

There are some risks and complications involved in any surgery. Those with tympanoplasty are ones common to any ear surgery due to the anatomy of the ear. There is a chance that the hearing can be worse or even total hearing lost with any ear surgery. This is of course very rare. It is not uncommon to get a little dizzy after ear surgery in the first 24 hours. However, this usually resolves after about 24 hours. It is very rare for dizziness to persist. It is not uncommon to have some taste disturbance after tympanoplasty. This usually involves a metallic taste that persists for two or three weeks and then resolves. Rarely does this persist. It is very uncommon to have injury to the nerve that moves the face, although this nerve does go through the ear. In rare cases is this nerve injured and can cause paralysis of the face necessitating further surgery .In some cases there are defects in the end bone that separates the brain from the ear. This can lead to a leak of spinal fluid or infection of the brain. This is again extremely rare.

About 95% of the time the hole in the ear drum is closed with tympanoplasty surgery. About one out of every 20 or 25 times the hole does not close and another surgery is required.

Tympanoplasty is the reconstruction of the middle ear leading to a healthy ear and improved hearing in most cases. Through modern day techniques this is feasible most of the time. If you have any questions about your particular problem and the surgery available to correct it, please contact us.

The content of this site is intended for information purposes only; it is not meant to take the place of seeing a healthcare professional. If you have any concerns regarding your own or someone else's health, we strongly encourage you to consult a physician.

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