Tympanoplasty (Repair of the Eardrum and Hearing)

Tympanoplasty is the operation for a hole in the eardrum and for long-standing middle ear disease. The surgeon repairs the eardrum and the hearing chain inside the middle ear, and clears the infection out of the middle ear and out of the mastoid bone behind the ear.

When the hole has to be closed

Some patients keep having discharge from the ear even when they protect it from water and have no infection in the nose or the sinuses. In these patients the hole has to be closed. Closing it improves daily life, stops the hearing loss getting worse, and prevents the serious problems that long-standing infection causes.

In the same operation the surgeon also treats any problem in the small middle ear bones that carry sound.

Cholesteatoma

Cholesteatoma is infected tissue that grows inside the middle ear and the mastoid bone and dissolves bone as it spreads. If the doctor finds it, the surgeon removes it as soon as possible.

In a patient with cholesteatoma, protecting or repairing the hearing comes second. The first aim is to clear the infection before it causes facial paralysis, hearing loss from the inner ear, or a complication inside the skull such as meningitis or a brain abscess.

Choosing the technique

The surgeon decides on the technique from several things: the state of the disease, the position of the hole in the eardrum, and the shape of the ear canal. Whether the mastoid bone behind the ear has to be opened also counts, and so do the preferences of the surgeon and the patient.

The operation can be done through the ear canal, from inside the ear, or through a cut behind the ear. A small hole can be repaired through the ear canal without any extra cut. A hole in the middle or the back of the eardrum is reached from inside the ear. A hole at the front, and any case where the mastoid bone has to be opened, is reached through a cut behind the ear.

What the eardrum is repaired with

The tissue used most often is the sheath of the temporalis muscle. It lies close to the operating field, so the surgeon can take it during the same operation. The covering of the cartilage in front of the ear canal can be used as well, and so can prepared materials such as sterilised pieces of dura.

The bones that carry sound are sometimes damaged and have to be repaired. The surgeon then uses prostheses made of various materials, pieces of cartilage taken from in front of the ear canal, or the middle ear bones themselves. Each is shaped and placed so that it carries sound again.

After the operation

Most patients have their dressing changed on the first day after surgery and go home. The special sponges in the ear canal are cleaned out after 10 to 14 days. Keep the ear away from water. Use the antibiotic and cortisone ear drops the doctor prescribes, to prevent infection and reaction in the operated area.

Healing is complete within three to four weeks. In the first month keep away from colds and from knocks to the ear, and do not fly.

The technical and functional success rate of this operation is generally high. It depends on how far the disease had spread and on the hearing level before surgery.