Simple Eardrum Hole Repair Operation
Myringoplasty, the eardrum surgery is the name given to the closure of small holes in eadrum. For this purpose, faty tissue, paper, silicone mebranes, muscle membrane (fascia), cartilage and cartilage membrane (perichondrium) can be used. When myringoplasty is combined with ossicular reconstruction, it is called tympanoplasty.
The aim of the eardrum surgeries (tympanoplasty / myringoplasty):
- Prevent recurrent ear infections.
- Improve hearing, if there is a conductive hearing loss due to eardrum perforation.
- Enable patients to swim or get ear wet without facing infection as a consequence.
The eardrum is both a barrier membrane and a vibrating membrane!
Our eardrum is located between the middle ear and the outer ear, and the barrier between these two ear parts is the membrane. So it has a barrier function. Apart from that, as a "vibrating membrane" as a surface area where sound waves hit, it has an "auditory" task in converting the energy of sound waves into vibrational energy and transmitting them to the middle ear ossicles and inner ear. When the integrity of the eardrum is disrupted, since the barrier function of the eardrum is impaired, microorganisms coming from the external ear canal by contact with water may cause them to reach the middle ear. Recurrent middle ear infections may occur. At the same time, depending on the reduction of the vibration surface, a decrease in the transmission of the energy of sound waves and conductive hearing loss may occur. Due to recurrent middle ear infections over time, sensorineural hearing loss may be added and mixed type hearing loss may occur.
Tympanic Membran Perforation - A Hole In The Eardrum
Tympanic membrane perforation defined as hole or tear in ear drum. This problem can cause to hearing loss and deterioration of barrier function of ear drum.
Perforations without infection or cholesteatoma are not painful. The patient may report audible whistling sounds during sneezing and nose blowing, decreased hearing, and a tendency to infection during colds and when water enters the ear canal. Perforation with infection typically results in copious purulent drainage, which may be sanguineous in both acute and chronic perforation. Surgeries to treat the eardrum (tympanoplasty or myringoplasty) can made according to perforation dimension and middle ear state.
Myringoplasty Technique
Eardrum Repair Animation
Myringoplasty techniques include the paper-patch method, fat-plug myringoplasty, a gelfoam plug in combination with surgical removal of the perforation edges, and fibrin glue or a patch composed of a hyaluronic acid ester and a dressing component.
We can perform transcanal (transmeatal, endomeatal) myringoplasty (without endaural incision or retroauricular incision and operation perform via the external auditory canal). With this techinique recovery time is shor and postoperative patient complaints less in comparison to other techniques.
Quality microscope and surgical experience required for the implementation of this technique.
Myringoplasty is often done under general anaesthesia, but it can be done under local anaesthesia also.
Myringoplasty is often done under general anaesthesia, but it can be done under local anaesthesia also.
Endoscopic Transcanal Myringoplasty
In the video above, you can watch the operation of closing the eardrum bee hole through the external ear canal with the help of the endoscopic system, without making any additional incisions. The cartilage and cartilage membrane used here were removed by making a 1 cm incision from the patient's ear region called the tragus, an area that cannot be seen from the outside. Many patients prefer this method because it is a minimally traumatic surgery, since there is no visible incision. I would like to emphasize here that; we can only perform endoscopic eardrum repair surgery in suitable patients.
Microscopic Transcanal Myringoplasty
Above, you can watch the video of myringoplasty operation performed inside the external auditory canal with the aid of a microscope. What was done in the video:
- the earwax in the external ear canal is removed - aspirated
- circular removal of white and dead epithelial tissue in the eardrum hole
- fresh bleeding areas are visible on the edges of the membrane hole
- fibrotic bands in the middle ear and surrounding the ossicles are removed
- pieces of sponge and small cartilages are placed in the middle ear for support purposes
- graft obtained from tragal cartilage and "prepared as an island graft" is being rehearsed
- the graft is placed overlay with the perichondrium outside and the cartilage inside
- all perforation edges are checked and additionally dried perichondrium is laid
- bleeding control is done
- after all the perforation is seen to be closed, pieces of sponge gel impregnated with antibiotic eye ointment and compressed are laid on the grafts
- a earpack is placed in the external ear canal, the operation is terminated by bandaging.
In this video that I shared with you here, no visible incision was made outside the patient's ear. According to the endoscopic technique, the surgeon has the opportunity to use both hands at the same time in the microscopic transcanal myringoplasty operation.
Perforated Eardrum Repairing Surgery (Endoscopic Transcanal Myringoplasty) Video
Myringoplasty Indications
Myringoplasty operation should be sutable in the following cases:
- Small, central and dry ear drum perforation
- Dry tympanic mebrane perforations (either central or marginal)
Myringoplasty Contraindications
Myringoplasty operation should not be performed in the following cases:
- Active discharge from the middle ear
- Middle ear cholesteatoma which can cause spontaneous drainage from the ear
- Uncontrolled nasal allergy
- When the other ear is dead (deaf ear)
- Patients with less than 3 years of age
Postoperative Patient Care For Myringoplasty Operation
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| Postoperative Patient Care For Myringoplasty Operation |
- Do not blow your nose until your physician has indicated that your ear is healed. Any accumulated secretions in the nose may be drawn back into the throat and expectorated if desired. This is particularly important if you develop a cold.
- Do not “pop” your ears by holding your nose and blowing air through the eustachian tube into the ear. If it is necessary to sneeze, do so with your mouth open.
- Do not allow water to enter the ear until advised by your physician that the ear is healed. Until such time, when showering or washing your hair, lamb’s wool or cotton may be placed in the outer ear opening and covered with Vaseline.
- If an incision was made in the skin behind your ear, water should be kept away from this area for 1 week.
- Do not take an unnecessary chance of catching cold. Avoid undue exposure or fatigue. Should you catch a cold, treat it in your usual way, reporting to your doctor.
- For avoiding constipation to eat foods of high in fiber and walking may be useful.
- Do not “pop” your ears by holding your nose and blowing air through the eustachian tube into the ear. If it is necessary to sneeze, do so with your mouth open.
- Do not allow water to enter the ear until advised by your physician that the ear is healed. Until such time, when showering or washing your hair, lamb’s wool or cotton may be placed in the outer ear opening and covered with Vaseline.
- If an incision was made in the skin behind your ear, water should be kept away from this area for 1 week.
- Do not take an unnecessary chance of catching cold. Avoid undue exposure or fatigue. Should you catch a cold, treat it in your usual way, reporting to your doctor.
- For avoiding constipation to eat foods of high in fiber and walking may be useful.
Myringoplasty Operation Fee
The cost of the myringoplasty operation varies between 3000 - 4500 US Dollars, depending on the hospital where the operation is performed and the materials used. Since it is an operation that is usually performed with the help of endoscopic and microscopic techniques; The operating conditions in the hospital are very important.
Is it Possible to Flight After Myringoplasty Operation?
After all eardrum operations, patients should be very careful while traveling by plane. It is appropriate to avoid air travel, which may cause pressure trauma, if possible, especially in the early period immediately after the operation. After the myringoplasty surgery, the tampons in the external ear canal can usually be removed 1-2 weeks later. Afterwards, we recommend our patients to travel by plane by paying attention to the following recommendations:
- squeezing decongestant sprays into the nose and relaxing the intranasal airway before the flight
- initiation of appropriate medical therapy to relieve nasal congestion if signs of upper respiratory tract infection or allergic rhinitis are present
- After the aircraft descent announcement, it is appropriate to regularly swallow and drink a little water.
Despite all these suggestions; Patients with severe nasal congestion should seek the opinion of their doctor before the flight.
Exercise, Swimming and Sports Activity After Myringoplasty
After all eardrum surgeries, it is ideal not to do sports activities that may cause trauma in the head area or cause sudden pressure increase in the middle ear for at least 1 month. However, walking, jogging, light lifting in sitting position can be done from the 1st week after the operation. It is necessary to be very careful about swimming in the pool and sea. Despite the swim plug, external ear canal cushion and similar materials that tightly close the external ear canal, despite the tight swim cap; swimming underwater is inconvenient for at least 6 periods after myringoplasty. There is a risk of both pressure change and water leakage into the ear. Even under a few meters of water, contact with tons of water can cause adverse changes in the surgical field.
Severe dizziness can be seen in patients with a perforated eardrum while swimming in cold waters
In people who have perforation in the eardrum and are unaware of this, jumping into the sea or ocean waters, cold water moves to the eardrum with pressure and then severe dizziness may occur. Sometimes patients may lose their sense of direction between the deep water and the surface, and in this case, a dangerous situation may arise. The diagnosis of tympanic membrane perforation is made in patients who apply to the clinic with a clear inflammatory ear discharge that starts later. I have patients who experience dizziness and earache while diving into the sea in this way.
Risks in patients with perforated eardrum and ear infections after repeated water contact
The external ear canal must be protected from water contact during bathing, walking in rainy weather, sweating during sports activities or wanting to swim in the pool or sea. In patients who do not take the necessary care about this contact and accept inflammatory ear discharge as a normal condition, negative effects such as changes in the structure of the middle ear ossicles, an increase in the diameter of the hole in the membrane, and the emergence of nerve damage in the inner ear occur over time; In the following periods, very severe complications such as facial paralysis, brain abscess, neck abscess, brain and cerebral membrane inflammation may occur. In patients with recurrent ear inflammation, instead of simple and minimally traumatic eardrum repair operations; more complicated surgeries that involve clearing the inflammation may need to be done.
If the eardrum is perforated, please do not drip onion juice and garlic juice into the outer ear with the information read on the internet!
In patients with a perforated eardrum, severe ear pain may occur after excessive acidic fluids such as onion or garlic juice are distilled into the external ear canal. Again, patients with a perforated eardrum should not drip oil, vaseline-based or oxygenated water-containing solutions into the outer ear canal in order to clean the dirt in the outer ear canal. Patients with intact eardrums can drip vinegar or lemon juice when they have itchy ears.
How is the eardrum perforated?
The eardrum can be perforated by traumatic (mechanical traumas, blasting, noise trauma) or infectious reasons. While only protection of the ear from water and waiting is sufficient for treatment in traumatic tympanic membrane perforations, medical treatment and follow-up may be required in tympanic membrane perforations associated with infection. Sometimes patients can puncture their own eardrums with the dirt aspirating apparatus sold on the internet; Sometimes the eardrum can be perforated due to an irrigation system such as sinus rinse, which is used incorrectly to wash the inside of the nose, and sometimes during an airplane flight. Most patients with acute eardrum perforation notice symptoms such as ear pain, bleeding from the ear and hearing loss.
Recommendations in acute traumatic eardrum rupture!
In acute traumatic eardrum perforation, it is usually sufficient to protect the ear from water contact and wait. Sometimes techniques such as placing the fat graft taken from the ear lobule into the perforation, making a paper patch on the outside of the hole can be used and can increase the rate of smooth closure of the hole. Ossicular chain damage and inner ear damage can sometimes be seen from traumatic eardrum injuries. In this case, ossicular chain reconstruction and restoration of hearing can be planned according to the amount of reserve permanent neural type hearing loss. Occasionally, acute tympanic perforation may be accompanied by acute sensorineural-type loss of the inner ear in patients exposed to loud bursts. Although the hole in the membrane can heal on its own; Damage to the inner ear has a lower probability of spontaneous atrophy. It can be planned to use various vitamins and drugs to increase blood circulation in these patients in order to reduce the damage to the inner ear cells and to regenerate the semi-living cells.
Grafts used in the repair of eardrum holes
Grafts can be prepared from the following tissues in our body that can be used in eardrum repair operations:
- muscle membrane (fascia)
- cartilage membrane (perichondrium)
- cartilage
- fat tissue
I usually use the graft obtained from the tragal cartilage during eardrum surgeries. After completely peeling off the perichondrium on one side, I circularly reduce the size of the cartilage and prepare an "island graft". Link where you can find information about island graft >> A Minimally Traumatic Eardrum Repair Technique: Transcanal Myringoplasty
Does the eardrum heal spontaneously when it is perforated?
Perforations in the eardrum that occur after trauma usually heal spontaneously within a few weeks, sometimes within a few months. If there is water contact or recurrent otitis media starts, the cells in the perforation edges begin to die and the possibility of complete closure decreases. Therefore, the ear should be protected from water contact and trauma during the healing period. It is necessary to intervene in the eardrum holes that do not heal spontaneously within a few months.
How long does it take for the eardrum to heal spontaneously when it is perforated?
In traumatic eardrum perforations, when the ear is protected from water contact, if the diameter of the hole in the eardrum is a few mm, full recovery is usually achieved within weeks or days; Healing usually takes up to 3 months in perforations involving most of the eardrum. Holes that do not close for more than 3 months will likely require surgical repair.
Is eardrum surgery risky?
Among the eardrum operations, they are myringoplasty operations that involve the least risk, are the simplest and involve the least anatomical changes. Since the eardrum is not completely dissected and removed in these operations, the risk of damage to the middle ear structures, facial paralysis or permanent hearing loss is close to zero. However, there is a risk of being affected in ear bee surgeries, middle ear ossicles and facial cyrus, in which the tympanomeatal flap is removed and the middle ear ossicles are intervened. In mastoidectomy operations, which is a slightly larger surgical procedure and involves the removal of inflammatory foci, in which the mastoid bone is not included in the middle ear nostril by rounding, greater risks such as the risk of facial paralysis, damage to the cerebral cortex, and the formation of a cerebrospinal fluid fistula may occur. The myringoplasty operation, which I shared with the scars in this article, is roughly the smallest eardrum operation and these risks are quite rare.
Eardrum perforation medication
If there is a traumatic and non-infectious perforation in the perforation of the kylac membrane, it is sufficient to protect the ear from water contact; Local antibiotic ear drops and oral antibiotic treatment may be required in eardrum perforations accompanied by bloody-inflammatory discharge that occurs after a middle ear infection. In bloody and punctured perforations in the eardrum, as long as there is no inflammation or fluid contact with the edges of the perforation, healing and repair of the membrane usually occurs until it reaches the tip. If traumatic perforation has occurred in the eardrum, it is inconvenient to drip ear wax softener oil-based drops into the ear.
Advantages of transcanal, minimally traumatic, microscopic or endoscopic eardrum operations!
The amount of pain felt, recovery time and operation risks are very high after operations performed through the external auditory canal (transcanal), in which the operation is completed with a microscope or endoscope half, without an additional incision visible from the outside, and the anatomical change is minimized by only interfering with the hole in the eardrum. less. Especially in patients with suitable features for this surgery, performing this less traumatic procedure increases patient satisfaction.
Link group where you can find detailed information about eardrum repair on this website >> https://www.ent-istanbul.com/search?q=eardrum+repair
Source links:
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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