Myringoplasty

This is repair of a perforation in the ear drum. The operation is almost always done under a general anaesthetic and is usually done as a day-case. Patients leave the hospital after a few hours and recover at home.

The operation can be done through the ear canal or from behind the ear. These days we try to do them all through the ear canal as it is less painful and just as successful as traditional behind the ear surgery.

Various grafts may be used to cover the perforation, but most commonly we use fascia from the temporalis muscle above and behind the ear, cartilage or perichondrium. These are harvested via a small incision behind the ear.

Why do we do it?

The operation is offered to try to prevent recurrent ear infections and to allow swimming and other water activities. The operation is sometimes offered to help with hearing and may be combined with a repair of the ossicular chain in the middle ear.

What we don't do it for.

The operation is not performed to improve tinnitus or balance.

When can't we do it?

The operation is less successful in young children and so, if a child needs the operation, we will usually wait until they are between 8 and 13 before we attempt it.

Some patients are too frail or have medical reasons why anaesthesia is not safe. In such cases, it is sometimes possible to do the operation under local anaesthetic.

How long does it take?

Most operations are done within an hour and a half, although some take longer than this.

How long does it take to recover?

If the operation is done through the ear rather than from behind the ear recovery is quite quick. Patients should not drive for the first 24 hours but after that they can return to normal activities. The ear will be a little painful but simple pain killers will address this. Healing of the perforation takes a few weeks during which time the patient should keep their ear dry. It is usually recommended that the patient does not swim for 6 weeks but the patient may travel by plane after 24 hours.

What are the benefits of surgery?

The operation works in 84% of patients. This means that their infections will stop and they will be able to get their ears wet. About 25% patient will notice that their hearing improves.

What are the risks?

All operations have risks. For myringoplasty these are:

1. Loss of hearing - 5% of people lose a little hearing and one in a thousand lose all of their hearing on the operated side.

2. Tinnitus - 3% of patients will notice new noises in their ears or worsening of their usual noises. The majority of these patients will settle down with time but some will need treatment for it

3. Taste change - the nerve of taste passes through the ear on its way to the brain. The operation sometimes disturbs this nerve. Around 0.5% of patients will have a permanent change in taste

Other risks include some dizziness, wound infections, and pain.

How is it done?

The two main ways of doing a myringoplasty are through the ear canal and from behind the ear. In both cases, once the surgeon is inside the ear, the operation follows a few short steps. In both cases, the graft will be placed under the drum and not on top of it.

First the ear will be cleaned. Wax and any mucus or pus is removed.

The second step it to examine the ear thoroughly to see if there are any other problems that may need correcting.

Next, the surgeon will 'freshen' the edges of the perforation. This is an important step and involves peeling the edge of the perforation to create a raw surface to graft upon. Of course, this makes the perforation slightly bigger.

Once the edges are freshened the surgeon will lift up the eardrum and have a look into the middle ear, clean it if necessary and test how mobile the ossicles are.

Dissolvable sponges are placed in the middle ear at this point. These will act as a support for the graft once it has been placed in the ear, under the drum.

Then the graft is placed onto the sponges and the drum is placed on top of the graft.

The last step is to put a dressing onto the surface of the drum to help with healing.

There are some pictures below which show this process. The only difference in the pictures is that the surgeon did not need to lift up the eardrum to put the graft in place. They were able to place the sponges and the graft through the perforation.

Step 1. Examine and clean the ear.

Step 2. Freshen the edges of the perforation.

Step 3. Place sponge into the middle ear under the drum.

Step 4. Place graft onto the sponges under the drum.

Step 5. Put dressings into the ear