A tympanoplasty is a surgical procedure that repairs or reconstructs the eardrum (tympanic membrane) to help restore normal hearing. This procedure may also involve repair or reconstruction of the small bones behind the tympanic membrane (ossiculoplasty) if needed. Both the eardrum and middle ear bones (ossicles) need to function well together for normal hearing to occur.
This procedure is usually not performed (or needed) in children under four years of age. A tympanoplasty is recommended when the eardrum is torn (perforated), sunken in (atelectatic), or otherwise abnormal and associated with hearing loss. Abnormalities of the ear drum and middle ear bones can occur through injury, otitis media, congenital (at birth) deformities, or chronic ear conditions such as a cholesteatoma.
Return to a normal range of hearing after tympanoplasty is dependent upon the extent of the abnormality. Surgeries that involve repair of the eardrum only usually have a success rate of 85-90%. A second operation may be necessary in some cases if the hearing is not restored to an acceptable level.
Tympanoplasty in most cases is an elective procedure, meaning that it can be scheduled whenever the patient is ready to have it done. Another option instead of this procedure includes the use of a hearing aid. When the tympanic membrane has a hole (perforation) in it, earplugs are usually recommended to protect the middle ear from infection. In a few cases, such as a significant infection or a cholesteatoma, this procedure may prevent more significant damage to the ear and the surgery may need to be performed more urgently.
Usually other ear, nose, and throat conditions are treated before a tympanoplasty is considered. For example, if an adenoidectomy is indicated, this surgery is usually completed before tympanoplasty.
Otitis Media of any type should not be present at the time of surgery, as infections in the ear makes the operation much more difficult and may ruin the reconstruction. If your surgeon has suggested certain medications prior to surgery, these should be done without exception to ensure a successful outcome.
A hearing test is performed to document any hearing deficiency. The more significant the hearing loss, the sooner the procedure should be performed. The eardrum will also be examined before surgery using a special operating microscope.
A tympanoplasty is performed with the patient fully asleep (under general anesthesia). A surgical cut (incision) is usually made behind the ear, the ear is moved forward, and the eardrum is then carefully exposed. The eardrum is then lifted up (tympanotomy) so that the inside of the ear (middle ear) can be examined. If there is a hole in the eardrum, it is cleaned (debrided) and the abnormal area can be cut away. A piece of fascia (tissue under the skin) from the temporalis muscle (behind the ear) is then cut and placed under the hole in the ear drum to create a new intact ear drum. This tissue is called a graft. The graft allows your normal eardrum skin to grow across the hole.
If needed, reconstruction of the middle ear bones (ossiculoplasty) or cholesteatoma removal may also be performed at this time.
This surgery usually requires an overnight hospital stay. The patient has a dressing (large bandage) over the surgical site. This is removed the next morning and the patient is discharged home. Occasionally, in older children, or those undergoing a less involved procedure, same-day surgery is possible.
Eardrops may be prescribed after discharge.
The most important part of this surgery for the parent is your part in restricting activity as outlined by your surgeon. By following these instructions very closely, you can make sure the result is the best it can be. Please refer to written post-operative instructions in your surgical packet .
Because this surgery takes place in and around the ear, there are special risks for this surgery in addition to the usual risks of infection and bleeding. Because each patient’s situation is different, your surgeon will relate to you just how likely these complications are to occur.
HEARING LOSS – A tympanoplasty is performed to help restore normal hearing. However, some hearing loss (more common with ossiculoplasty) may still be present after the procedure. An operation is termed successful if the hearing is restored within 10-15 decibels of normal.
FACIAL NERVE INJURY AND PARALYSIS – Because the facial nerve runs close to the surgical site, injury although uncommon, can occur. This may result in temporary facial muscle weakness and/or loss of taste on one side of the tongue.
DIZZINESS – This complication after surgery is rare and is more likely to occur when mastoidectomy is performed for cholesteatoma when the cholesteatoma has eroded the balance system.
LOSS OF GRAFT – Because this operation involves grafting using your own tissue, very rarely this tissue will not survive long enough for the hole in the eardrum to heal completely. In this case, another operation may be necessary. Because the success rate of this surgery is so high, re-operation also has a very high success rate.
Your surgeon will schedule follow up visits after surgery to look at the eardrum, to check hearing and to ensure normal healing. It is important to keep these appointments, as they will help to maximize the success of the procedure.