Tympanoplasty Surgery: Everything You Need to Know

Tympanoplasty is the surgery used to repair a ruptured eardrum either on its own or as part of a larger operation involving the middle ear. When the surgery involves just the eardrum, it is called myringoplasty.

Tympanoplasty is an inpatient procedure that is commonly performed under general anesthesia and sometimes local anesthesia. It takes two hours or more to perform depending on the extent of damage to the eardrum (tympanum) and/or the bones of the middle ear (ossicles).

This article describes what is involved in tympanoplasty, including the side effects, risks, and what to expect before, during, and after surgery.

Types of Tympanoplasty

Tympanoplasty is a surgery used in adults and children to treat a perforated eardrum and/or to reconstruct or repair the bones of the middle ear.

There are five types of tympanoplasty used by specialists known as surgical otolaryngologists:

• Type 1: Used to repair a hole in the eardrum with a graft (myringoplasty)
• Type 2: Used to repair the eardrum and ossicles
• Type 3: Used to remove the larger ossicles (called the malleus and incus) and connect the eardrum directly to the smaller ossicle (called the stapes)
• Type 4: Used to repair defects in the stapes
• Type 5: Used to remove some of the bone from the ear canal, called the mastoid bone, to improve the transmission of sound (mastoidectomy)

Depending on the condition being treated, the surgery may be approached through the ear canal or through an incision behind the neck.

Purpose of Tympanoplasty

Tympanoplasty is indicated for the repair of ear injuries or to correct problems in the middle ear that impede hearing.

The indications for tympanoplasty include:

• Perforated eardrum
• Chronic or recurrent middle ear infection (otitis media)
• Reconstruction of damaged or malformed ossicles
• Placement of a middle ear hearing aid
• Placement of a cochlear implant

Myringoplasty is typically performed when a perforated eardrum hasn't healed on its after more than three months.

Surgical Risks

As with any surgery, there is a risk associated with tympanoplasty, including the risks of general anesthesia.

Possible risks of tympanoplasty include:

• Pain
• Bleeding
• Ear infection
• Dizziness
• Failure of the eardrum graft to survive
• Worsening hearing loss
• Ringing in the ear (tinnitus)
• Deafness
• Facial palsy due to facial nerve injury

Your surgeon will weigh the potential risks and benefits with you so that you can make an informed choice.

How to Prepare

If you're having a tympanoplasty, be sure to follow your surgeon's instructions to avoid anything that might delay your surgery or place your health at risk. This includes any medications or supplements you take that may be inappropriate for surgery.

Location

Tympanoplasty is performed in a hospital since general anesthesia is typically involved,

What to Wear

It's best to wear clothing that is loose, comfortable, and easy to remove. Zipped or button-up tops will help you avoid brushing against your ear as it heals. You'll be given a hospital gown to wear during your procedure.

Don't wear any jewelry to your operation, especially earrings. Leave them at home.

Food and Drink

Food and drink will need to be restricted before surgery. Adults are generally advised to avoid all food and drink starting at midnight on the eve of surgery. This rule also applies to children over one year of age.

Clear liquids may be consumed up to two hours before surgery.

What to Bring

While tympanoplasty is usually an inpatient procedure, some people may be advised to stay overnight for observation. If so, bring only what you need, such as a toothbrush, change of clothes, slip-on shoes, and chronic medications.

Aso bring your ID, credit cards, insurance information, and any necessary paperwork requested by the hospital intake staff.

What to Expect on the Day of Surgery

If you're anxious about your upcoming surgery, knowing what to expect can help ease your nerves.

Before the Surgery

Immediately before the surgery, you will need to complete some paperwork, meet with the anesthesiologist to review the sedation plan, and have your vital signs checked by the nursing staff.

Once you are OKed for surgery, an intravenous (IV) drip will be placed in a vein in your arm to deliver fluids, medications, and anesthesia. Adhesive probes will be placed on and around your chest to monitor your heart rate on an electrocardiogram (ECG) machine.

Finally, a hinged device called a pulse oximeter will be placed on your finger to monitor your blood oxygen levels.

During the Surgery

Depending on the condition being treated, different surgical techniques may be used. This describes the typical approach for myringoplasty:

The surgeon starts by taking tissue from the back of your ear to use as a graft. Artificial graft material can also be used.

The surgeon will then approach the eardrum either through the ear canal or by making an incision immediately behind the ear. The first option is preferred as it is less invasive (and involves a narrow scope, called a transcanal endoscope, that helps direct the procedure).

After the eardrum is gently lifted, the surgeon will patch the hole with the graft. Dissolvable packing is then placed to keep the graft secure until it is amply healed. A temporary surgical drain may be inserted if an incision behind the ear was used.

From start to finish, myringoplasty takes an average of two hours to complete.

If the ossicles are damaged or need repair, additional procedures may be needed. In some cases, a prosthetic device can be inserted to replace or support them.

After the Surgery

Unless there are complications, you should be released to go home after spending one night of observation in the hospital following your procedure. Sometimes you may even be discharged and allowed to go home on the same day as the surgery.

Someone will need to drive you home, whether you go home the same day or the next day since it takes several hours for the anesthesia to fully wear off before it is safe to resume driving.

Once you're cleared to go home, you'll be given discharge instructions. It's crucial to follow your surgeon's advice and take it slow, even if you're feeling well. Doing too much, too fast, can hinder your body's ability to heal, prolonging the recovery process.

Strenuous exercise, straining, and heavy lifting (anything over 20 pounds) should be avoided for at least two weeks.

To reduce swelling, elevate the head of your bed when you sleep. It can also take some time for hearing to improve after a tympanoplasty, so be patient with your results in the early days of healing.

Recovery

After a tympanoplasty, you should plan to take one to two weeks off from school or work for recovery.

Your healthcare provider will schedule you for a follow-up visit about a week after the procedure to check for signs of infection and remove your stitches. If you're healing well, you'll be cleared to get back to your usual activities.

Follow-ups will be scheduled to evaluate your body's healing and remove any packing material that doesn't dissolve on its own.

Healing

Some drainage is normal in the first three to five days after a tympanoplasty. A sterile cotton ball can be used to help keep the area dry. Your healthcare provider will provide ear drops for use following surgery.

Swimming and flying in an airplane are prohibited immediately after tympanoplasty until your healthcare provider says otherwise. Do your best to keep incisions dry as they heal.

Persistent vomiting and difficulty standing or walking should be reported immediately to your surgeon's office.

Long-Term Care

It can take two to three months after tympanoplasty before a full recovery is achieved. During this period, your hearing will improve as the packing material fully dissolves over time.

Your healthcare provider will do a complete hearing test eight to 12 weeks after surgery. Follow your surgeon's instructions to ensure a safe recovery, and you should be back to normal in no time.