Tympanoplasty is a surgical procedure performed to reconstruct the eardrum when it has been badly torn or perforated. The eardrum, a membrane between the outer ear and middle ear, also known as the tympanic membrane, vibrates to assist in the hearing process. When the eardrum is damaged, hearing loss often occurs. A perforation of the eardrum may also cause severe pain, dizziness or bleeding from the ear.
Reasons for Tympanoplasty
There are several reasons a tympanoplasty may need to be performed. Occasionally, such surgery is performed to treat certain types of congenital deafness. More common reasons for this operation include injury to the tympanic membrane due to:
- Serious middle ear infection
- Insertion of an object into the ear canal
- Accidental injury during ear tube placement
- Traumatic injury
- Extreme changes in ear pressure, or barotrauma
Everyone experiences changes in ear pressure at some point, but barotrauma due to a blocked eustachian tube, may, in extreme cases, cause the eardrum to rupture. This may occur as a result of:
- Exposure to extremely loud noise
- Airplane travel
- Scuba diving
- Traveling high in the mountains
- Nasal congestion due to an upper respiratory infection or allergic reaction
While a bad ear infection may be the cause of the rupture of the tympanic membrane, the perforation will also make the ear more susceptible to infection since the eardrum serves as a protection membrane keeping germs from entering the inner ear.
Diagnosis of Eardrum Perforation
Whenever there are symptoms of pain, discharge or bleeding from the ear, or hearing loss, a doctor should be consulted since these symptoms may be the result of eardrum perforation. Sometimes, when the eardrum is perforated, the ossicles, or small bones behind the eardrum, are broken as well. When this happens, hearing loss may be severe. Eardrum perforation is diagnosed by an examination of the ear using an instrument known as an otoscope. A hearing test may be performed to evaluate whether the patient has sustained any hearing loss.
Minor eardrum perforations often do not need any treatment, as the hole will close by itself within a few days. Antibiotics, ear drops or decongestants may help dry fluid accumulations and clear lingering infections during this process. If a perforation persists for many weeks, or if there is continued ear infection which does not respond to antibiotic treatment, surgical intervention may be necessary.
There are actually several surgical procedures which may be done to repair the ear drum. All involve the surgeon making a cut either behind the ear or inside the ear canal and cleaning out any infected or dead tissue from the site. If there is only a small hole in the eardrum, the doctor may be able to perform a lesser procedure, called a myringoplasty, which involves placing special paper or gel over the damaged area. This surgery usually takes half an hour or less to perform. If the full tympanoplasty is necessary, the surgeon with patch the eardrum with a piece of the patient's own tissue, usually taken from elsewhere on the ear. This procedure usually takes 2 to 3 hours. Over time the skin of the eardrum will grow over the repair.
In some cases, when the eardrum is perforated, there may be fractures of the small bones of the inner ear, called ossicles, as well. This happens frequently in children as a result of ear infections. When this occurs, the bones involved must be removed, repaired or replaced. If this surgery, called an ossuculoplasty, or ossicular reconstruction, is necessary, it is often performed at the same time as the eardrum repair.
A tympanoplasty procedure is usually performed outpatient, meaning patients are able to return home later the same day.
Risks of Tympanoplasty
While a tympanoplasty is considered a safe and effective procedure, there are risks associated with any type of surgical procedure. Risks of a tympanoplasty may include:
- Excessive bleeding
- Breathing problems
- Adverse reaction to anesthesia
- Hearing loss
- Facial nerve injury
These complications are considered rare and are minimized by having an experienced and skilled surgeon perform the procedure.
Recovery from Tympanoplasty
For a few days after a tympanoplasty, the patient will experience some soreness and ear pain which may be treated with pain medication. There may also be some drainage from the ear. These symptoms usually subside quickly. Patients must be careful to keep the ear clean and dry after surgery in order to promote healing and lessen the risk of infection. For the first week, packing is usually kept in the ear and sometimes a dressing covers the outer ear as well.
The symptoms experienced before the surgical procedure, such as hearing loss, usually abate quickly after the tympanoplasty procedure. During the period immediately following a tympanoplasty, patients should refrain strong nose blowing, swimming and air travel and try to avoid crowds in an effort to avoid respiratory infections.