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Tympanoplasty

General Background

The eardrum, or tympanic membrane, is located deep within the ear canal. It can sometimes develop a hole in it, known as a tympanic membrane perforation. Causes of tympanic membrane perforations include trauma, either directly from objects like Q tips, or indirect, such as concussive forces from a slap to ear, and infection. The tympanic membrane helps amplify sound, and any defects in it can cause a decrease in hearing. Repairing the defect requires the placement of thick graft tissue, known as fascia, which is usually harvested from behind the ear.

The Procedure

The procedure for tympanoplasty takes place under general anesthesia or IV sedation and takes approximately one to two hours. This is done either by itself or in conjunction with other procedures including mastoidectomy and ossicular chain reconstruction. The procedure is typically done from within the ear canal, but in cases when the canal is narrow, an incision is made behind the ear to access the ear canal. The tympanic membrane is carefully elevated from the surrounding canal, and the fascia graft is place in the hole. This graft is harvested from muscle located behind the ear. The graft is held in place by a supporting layer of absorbable gelatin sponges placed in the middle ear and on top of the graft.

After Surgery

After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild, and is resolved by taking the prescribed pain medications. Do not be concerned regarding your hearing during the healing process. It takes 6 - 8 weeks before we can evaluate improvement and your hearing will be tested at that time. Bloody or watery drainage from the incision area may occur during the first 7 - 10 days. If this happens tape a piece of gauze over the area. Call the office if this persists longer than 10 days or if it develops an odor, swelling, or pain. Water should be kept out of the ear until it is healed. You may take a shower 2 days after the surgery provided you cover the ear with a cotton plug soaked in ointment and a shower cap to cover your head. The hair may be shampooed separately outside of the shower 3 days after surgery providing water is not allowed to enter the ear canal. Do not blow your nose with force for 2 weeks. If you sneeze, do so with your mouth open. Ear drops should be used as prescribed. No bending, lifting, straining aerobic exercise, heavy work or traveling until approved by your surgeon. DO NOT USE ASPIRIN OR IBUPROFEN PRODUCTS FOR 2 WEEKS POST-OP. No flying for six weeks post operatively.

Risks of Surgery

There are several risks associated with tympanoplasty. Though the success rate of surgery is high (>90%), there is a risk of failure with a persistence of the hole in the eardrum. If this occurs, revision surgery may be necessary. Another risk is alteration in taste. This can occur because the nerve which is responsible for taste on that side of the tongue runs on the undersurface of the tympanic membrane and may be damaged from the perforation. The taste loss is usually temporary and typically recovers after several weeks. Another risk is some unsteadiness following the surgery, which may last up to six months; in rare cases it is a permanent condition. On rare occasions the hearing may worsen after surgery, and may require possible adjunctive procedures to correct it. Damage to the facial nerve, which controls movement on that side of the face, is a very slight risk of this surgery. This can result in facial weakness; when this occurs, it is usually temporary and typically recovers after several weeks, but occasionally can be permanent. The incidence of postoperative infection is less than 5%. Infections are usually successfully treated with antibiotics. Postoperative bleeding can usually be controlled by packing or a tight dressing but, occasionally, a second operation is required.