Tympanoplasty
An advanced surgical procedure that repairs a damaged eardrum and restores hearing while reducing the risk of recurrent infections
What is tympanoplasty?
Tympanoplasty is the reconstruction of the eardrum. Your surgeon lifts the remaining drum, places a graft of your own tissue underneath or alongside the opening, and supports it while your body grows a new layer of skin and lining across it.
The graft is taken from you, through the same incision or a small separate one. Temporalis fascia, the tough sheet covering the muscle above the ear, is the traditional choice. Cartilage with its covering membrane, taken from the small flap in front of the ear canal or from the bowl of the ear, is now widely used because it resists collapse and gives a more reliable take, at the cost of a slightly stiffer drum.
Where the tiny bones behind the drum are also damaged or eroded, they can be reshaped or replaced with a small prosthesis during the same operation, and your surgeon will not always know this is needed until they are looking. Ask beforehand whether it is a possibility in your case.
What it involves
This is a Day Care operation under general anaesthetic, so you are fully asleep and remember none of it. Do not eat for six hours or drink for two beforehand, and arrange for an adult to bring you home and stay overnight.
The ear is reached in one of three ways: entirely through the ear canal, through a small cut just inside the rim of the ear, or through a cut behind the ear that lets the surgeon fold it forward. Which one is used depends on the size and position of the opening and on the shape of your ear canal. An endoscope is used in many centres to work through the canal alone, which avoids an external cut.
The operation takes one to two hours. Dissolvable packing is placed in the canal to support the graft, and a dressing goes over the ear.
You rest on the ward for a few hours and go home the same day, with painkillers, antibiotic drops in most cases, and a date for the packing to be reviewed.
Recovery
The ear aches for two to three days and feels blocked and full for considerably longer, because it is packed. Your hearing will be worse than before the operation for the first few weeks, and that is the packing and not the result.
Most people take a week off work and two to three weeks off heavy or dusty work. No swimming, no diving and no flying for six weeks. Keep the ear completely dry: a ball of cotton wool smeared with petroleum jelly at bath time, no shower spray into the ear, and no hair wash without protecting it.
Do not blow your nose for three weeks, and open your mouth when you sneeze. Pressure driven up the tube from the nose is what lifts a healing graft off.
Packing is removed or has dissolved by three to six weeks. Your true hearing is assessed at about three months with a formal test, and that is the number to judge the operation by. Mild popping, clicking and occasional sharp twinges during healing are normal.
Questions about tympanoplasty
How much will my hearing improve?
Where the loss came from the opening in the drum alone, most people gain a useful amount of hearing, and closing the drum reliably improves a conductive loss of mild to moderate degree. Where the small bones behind the drum are also damaged, the gain depends on how well they could be reconstructed. Where there is nerve-related loss in that ear as well, that part does not change, since the operation works on the conducting mechanism only. Your hearing will be worse than usual for the first few weeks because the canal is packed. The real result is measured at about three months.
Will I be able to swim afterwards?
Usually yes, and that is one of the reasons people choose the operation. You must keep the ear completely dry for six weeks: no swimming, no diving, no shower spray into the ear, and a petroleum-jelly-coated cotton ball at bath time. Once your surgeon has confirmed at your follow-up that the graft has taken and the drum is intact, most people swim normally at the surface. Diving and deep underwater swimming are discussed separately, because pressure behaves differently on a reconstructed drum. Get the confirmation from an examination and do not assume it from the calendar.
What happens if the graft does not take?
The graft closes the drum in the large majority of cases. It fails in the order of one in ten, more often with large openings, in smokers, and where the tube from the nose to the ear works poorly. Failure usually shows as a small residual opening at the follow-up examination, and not as anything you would notice yourself. A small residual hole is sometimes left alone if it causes no trouble, and otherwise a second operation is offered once everything has settled, often at six months or more, and frequently using cartilage for a stronger repair. Stopping smoking before surgery measurably improves the odds.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about tympanoplasty
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one