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.

Beneficial Effects of Closure of Eardrum Perforation

If you have a hole in your eardrum, the problems it may cause for you in terms of your health are problems related to hearing and the barrier function of the eardrum. When the eardrum is perforated, that is, in the eardrum perforation, different symptoms may occur depending on the location of the hole in the membrane and the size of the perforation. Normally, our eardrum is a membrane-shaped anatomical structure that acts as a barrier between the middle ear and the outer ear. The eardrum basically has two functions. The first is the separation of the middle ear from the outer ear canal by acting as a barrier between the middle ear and the outer ear canal, preventing the microorganisms that can come through the outer ear canal from reaching the middle ear. In other words, the eardrum acts as a barrier. The second important task of the eardrum is the vibration of the sound waves coming from the external ear canal by hitting it on itself and the transfer of this vibration energy to the inner ear with the help of 3 ossicles in the middle ear. In other words, when the eardrum has a hole, there will be a decrease in the surface area hit by sound waves in varying amounts depending on the size of the hole, and therefore the vibration energy will be less. The result will be conductive hearing loss. As the diameter of the eardrum perforation increases, the vibration surface will decrease, the probability of hearing loss and also the barrier function will decrease, and the probability of recurrent middle ear infections and related complications increases. When eardrum perforations are small, they may not show any symptoms; however, regardless of whether the perforation of the eardrum is small or large; Since the barrier function is impaired, patients should protect their ears from water contact during bathing, swim superficially during swimming and use very tight ear pads. It is not always possible to protect the ear from water contact in patients with a perforated eardrum. If you walk in the rain, do a sportive movement that can cause sweating, and accidentally get water on your face, there is a possibility of water in the middle ear. In patients with a hole in the eardrum, the frequency of otitis media increases due to the deterioration of the function of the eardrum, and various changes in anatomical structures may occur due to recurrent middle ear infections, and complications related to the spread of infections to neighboring areas may occur. In patients with a hole in the eardrum, various complications such as chronic otitis media, deformation of the middle ear ossicles, mastoiditis, meningitis due to recurrent infections, brain inflammation, neck and cerebrovascular inflammation, facial paralysis may occur, albeit rare. Closing and repairing the perforation of the eardrum can eliminate the risk of developing these future complications in patients, and anatomical adverse effects can also be eliminated. In patients with tympanic membrane perforation and recurrent otitis media, damage to the cells of the inner ear may occur over time due to contact with inflammation. Especially in patients who are young and have eardrum perforation, surgical procedure is more appropriate in terms of eardrum repair; follow-up can be planned for elderly patients who have no complaints and have perforation of the eardrum. An important condition that may affect the success of the surgery in terms of eardrum perforation is; it is to protect the patient's ear from serious water contact and to have a healthy middle ear that has not been infected. If we want to briefly summarize the beneficial effects of a successful eardrum surgery for you, it can be counted as being able to swim freely without placing any outer ear pads while swimming in the water during vacation periods, preventing middle ear infections from being seen anymore, protecting the patient from risks related to infection, increasing the level of hearing, and better perception.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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