A Minimally Traumatic Eardrum Repair Technique: Transcanal Myringoplasty

Closure of Eardrum Hole Without Visible Skin Incision

Hearing loss and recurrent middle ear infections, which may vary depending on the location and size of the hole, can be seen in patients with a hole in the eardrum. Especially in selected patients with healthy and normal middle ear mucosa, without chronic otitis media or cholesteatoma, tympanic membrane operations can be performed "transcanally", that is, through the canal of the external auditory canal. Sometimes with endoscopic and sometimes microscopic technique, this operation can be performed only through the outer ear canal. On this subject, you can take a look at the Different Details on Endoscopic and Microscopic Eardrum Surgery article that I prepared before. 

It can be done to close the holes in the eardrum, to increase the hearing level of the patients and to prevent recurrent middle ear infections. In other words, it is aimed that the eardrum can perform its barrier function and hearing-related function again. Link where you can find detailed information >> Perforated Eardrum - Definition, Causes, Symptoms, Treatment

Myringoplasty, which is generally the smallest surgical procedure among eardrum hole repair procedures, can be performed without a visible skin incision. Link where you can find detailed information >> Myringoplasty Operation in Istanbul, Turkey

In this operation, the most commonly used graft materials to close the eardrum hole are cartilage, cartilage membrane (perichondrium) and muscle membrane (fascia). After an incision of approximately 2 cm on the inner side of the protruding area just in front of the ear canal, called the tragus, the cartilage graft can be taken very easily.

Island Graft Preparation From Cartilage

Island Graft - Cartilage Graft Preparation
Island Graft For Tympanic Membrane Repairing
In the image above, the cartilage graft prepared in a nearly round shape, and the perichondrium in its larger outer part are seen. The notch-shaped area excised from the cartilage is placed on the manubrium mallei. A well thought-out graft preparation technique with a low probability of slipping into the middle ear or rotating in place when placed overlay. Scientific article link where you can find detailed information >> Preparation and placement of cartilage island graft in tympanoplasty

As seen in the photo above and the video above, the "island graft" is a very cleverly prepared cartilage graft used to close the eardrum hole. 

How is this graft prepared?

Cartilage graft taken from the tragus with perichondrium on both sides is removed by peeling the perichondrium on one side. The cartilage section is brought into a nearly round shape by removing the outer edges with the help of an elevator. In this way, the circular shaped cartilage and the perichondrium, which is slightly wider than it, remain. Then, a notch-shaped or triangular piece of cartilage is removed to fit the "malleus", which is the tongue of the tongue in the middle ear, and a vir image is revealed, as in the photo above. In this graft, which is usually "overlay", that is, placed over the eardrum hole, the cartilage is inside and the perichondrium is outside. In "island grafts" prepared in this way, the possibility of the graft falling into the middle reaches and the possibility of slipping of the graft are reduced. As seen in the video above, at the end of the operation, the unilateral perichondrium, which is removed by peeling the cartilage, can be dried on the operating table and laid as the outermost graft. You can see by following the above video.

It is an aesthetic and minimally traumatic eardrum operation as there is no additional skin incision!

The tympanic membrane surgery, which I have shared here and performed as "transcanal", requires surgical experience and is frequently preferred in selected patients because it is an ideal method.
Audiometric tests and thin-section temporal bone tomography may also be requested during detailed examination before eardrum surgery in patients who are planning an eardrum operation in Istanbul. In patients with signs of infection in the mastoid bone, chronic suppurative otitis media or otitis media with cholesteatoma, patients who require additional ossicular chain reconstruction, much more complicated operations may be required than the operation I have shared with you here. Unlike the endoscopic transcanal myringoplasty operation, the surgeon can use both hands at the same time in the microscopic transcanal myringoplasty operation.

Hospital conditions, microscope features are also important!

The instruments and operating microscope used during the recording in this video are very high quality and high resolution devices. For this reason, it is ideal to perform minimally traumatic eardrum operations in well-equipped, quality hospitals.

What is the Cost of this Operation?

I usually prefer to perform this operation in well-equipped, high-quality hospitals, and the average cost, including one day hospitalization, doctor and material fees, is around 3500-4500 US dollars.

Post-Operative Care Recommendations

We usually advise our patients to avoid pressure trauma and water contact to the ear for several months. The tampons in the external ear canal can stay for 1-3 weeks, and then antiseptic solutions can be recommended to the external ear canal. It is normal for patients to have an annoying "crunchy, slippery and wet sound" from the ear during mouth opening or swallowing, which may occur a few days after the operation. We advise our patients to be careful about keeping their mouth open during sneezing and not to hit the ear. During the flight, especially when the descent begins, it is necessary to pay attention to the recommendations of our patients, such as medical treatments that relieve the nasal airways, intermittent swallowing or drinking water. You can find detailed information in the links above.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
E-Mail: muratenoz@gmail.com 
Mobile phone: +90 533 6550199
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