Myringoplasty

PLEASE NOTE - THIS INFORMATION IS INTENDED FOR GUIDANCE ONLY. IT IS NOT IN ANY WAY A SUBSTITUTE FOR A SPECIALIST CONSULTATION.

Why is myringoplasty carried out?

A myringoplasty is an operation to repair a perforation (hole) in the ear drum.

The usual reason for performing it is to try to prevent the repeated infections that a perforation can cause. Some people with a perforation don't get many infections but would prefer not to have to wear an ear plug for showering, bathing or swimming. This is also a perfectly valid reason for surgery.

A perforation can also cause hearing loss and sometimes repairing the perforation can improve hearing. However the results of myringoplasty in terms of improving hearing are surprisingly unpredictable, because as well as the perforation there are sometimes also problems with the small bones of hearing (malleus, incus and stapes). We don't usually recommend myringoplasty if the only problem with the ear is hearing loss, unless people are willing to consider the possibility of a second operation at a later date to repair the bones of hearing, known as an ossiculoplasty. Unfortunately it is often not possible to perform a myringoplasty and ossiculoplasty at the same time.

Are there any alternatives to surgery?

If people are experiencing repeated infections, the first thing we would recommend is being very careful to keep all water out of the ear, if necessary with the help of a custom-fitted ear plug.

In children we usually try to wait until about the age of 10 before carrying out a myringoplasty, although this is not a hard and fast rule and we will look at each child individually from this point of view.

How is the surgery performed?

Myringoplasty is almost always carried out under a general anaesthetic (you are completely asleep).

The operation normally takes between 1 and 1 1/2 hours.

Depending on the size and position of the perforation the operation may be carried out via the ear canal with a very small scar just inside the ear, with a small scar just in front of the ear or with a scar behind the ear. We will tell you before the operation which approach we are planning to use.

We will use a graft of your own tissue to repair the perforation. This is usually either a thick fibrous tissue that covers the temporalis muscle just above the ear or cartilage, which we will take from inside the ear.

We normally lift up the ear drum and place the graft under it. The ear drum is then held back in place with a dressing or "pack" in the ear canal.

The wound is then closed with dissolving stitches under the skin.

What can I expect after the surgery?

You will probably have a bandage around your head when you wake up. This is to reduce the risk of bleeding or extensive bruising.

The bandage will be removed before you go home. If your operation is in the morning you will normally have the bandage removed and be allowed home after 6 hours if you are well enough. If your operation is in the afternoon it is likely you will need to stay overnight.

You will be given some pain relief to take home.

Because the sutures are dissolving and buried under the skin you will not need to have any sutures removed.

While the pack is in place, the hearing in that ear will be reduced. The pack will be removed at your out-patients appointment 2 weeks after the operation. You will normally be given a one week course of antibiotic ear drops to use after the pack has been removed.

The pack is important because it holds the ear drum back in place and stops the ear canal from narrowing down as a result of scarring. If the pack falls out within the first 10 days after the operation it is important that you get in contact, either via the ward or the appropriate secretary, as it may need replacing. The pack looks like a short piece of crumpled ribbon and may be yellow or brown.

You may get small amounts of discharge or bleeding from the ear during the healing process, and this is generally nothing to worry about. However if there is a lot of discharge or if it starts to smell offensive  you may have an infection and should either consult your GP or get back in contact directly.

Similarly if the wound or external ear start to look red you should seek medical advice.

You should plan to take 2 weeks off work following the operation. Children should generally plan to take 2 weeks off school. There is some flexibility in this. If you have a sedentary job or can work from home you may be able to return to work sooner if you wish, but if you have a physically demanding job you may need a little longer. We will, of course, be happy to discuss this with you.

You will need to continue to keep water out of your ear for at least 6 weeks following the surgery.

You should avoid flying for at least 6 weeks after the operation.

What are the risks of the surgery?

All operations, however carefully and expertly they are carried out, have risks attached.

Whilst we always do our best to operate only when we think there is a good chance of the surgery being successful, there is always a chance that the symptoms we are trying to treat may not improve following the operation.

The success rate for myringoplasty varies from about 60% for very large perforations to close to 90% for small ones. This does obviously mean that there is a chance that the operation will be unsuccessful. If the perforation fails to close or comes back, the operation can usually be repeated at a later date.

As with almost any operation there is a small risk of post-operative infection, bleeding or bruising, and a chance that the scar will be noticeable or not heal properly.

If you have a scar behind your ear you may notice some numbness of the top part of the ear. This will almost certainly settle down with time, but may take a few months to settle completely.

There is a very small risk of the hearing getting worse as a result of the surgery, and a tiny risk of complete hearing loss in that ear. The hearing in the othe ear would, of course, be unaffected.

Hearing and balance are very closely related, and there is also a very small chance of some dizziness or loss of balance following the surgery. If this were to occur it would be almost certainly be temporary.

There is also a small risk of developing some tinnitus (noises in the ear), but again this would be likely to settle down quite quickly.

The nerve that supplies taste to the tongue on that side runs through the ear drum on its way to the tongue. When we lift up the ear drum this nerve occasionally gets stretched or damaged. If this happens you may notice either a loss of taste down that side of the tongue or an odd, metallic taste. If this does happen it is almost always temporary, but may take several months to settle down completely.