(Tympanic Membrane Reconstruction)
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.