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Hole in the eardrum and Myringoplasty

In a nutshell

  • A hole in the ear drum does not always need repair

  • Myringoplasty is an operation that repairs a hole of the ear drum. It is usually a day case under general anaesthetic

  • Usually the hearing improves after the operation.

What is Myringoplasty ?
It is a type of surgery that repairs a perforated or torn eardrum. The eardrum, or tympanic membrane, is a thin, flexible membrane that separates the outer ear from the middle ear. It vibrates when sound waves hit it, allowing us to hear. A
perforated eardrum can occur due to various reasons, including trauma, infections, or prolonged exposure to loud noises. Myringoplasty aims to close the perforation, restore the integrity of the eardrum, and improve hearing, while also reducing the risk of ear infections.

Myringoplasty
Myringoplasty

Why has my ear drum perforated?
It can be caused by a variety of factors, as

  • Middle ear infections (otitis media)

  • Trauma (e.g., a blow to the ear or insertion of foreign objects)

  • Sudden pressure changes (barotrauma, as experienced during flying or scuba diving)

  • Exposure to loud noises (e.g., acoustic trauma)

  • Chronic ear infections or untreated otitis media

What symptoms will I have with a perforated ear drum?

Usually a small hole does not cause any symptoms.

  • Bigger holes can cause hearing loss, ear discharge, infections or ringing of the ears

Do I necessarily need surgery?
No. Most of the times the hole in the eardrum does not cause any symptoms, such as infections or a considerable hearing loss to need further treatment.
 

In any case, it is important to prevent water (tap water, pool or sea water) from getting into the ear, as this can trigger an infection. A good practice is to put a piece of cotton wool covered with Vaseline at the entrance of the ear canal, so to create a watertight seal and prevent water f from getting in. When swimming, it is advisable to use swimming ear plugs.

 

All you need is monitor your symptoms.

When is surgery indicated?
There are occasions though, that myringoplasty is needed when the hole causes significant symptoms or poses a risk to ear health.

 

The key reasons for considering myringoplasty include:

  • Hearing Loss: A perforated eardrum can reduce hearing ability, often due to the inability of the eardrum to vibrate properly in response to sound waves. Myringoplasty can help restore hearing by closing the perforation.

  • Recurrent Ear Infections and ear discharge: A hole in the eardrum can increase the risk of frequent ear infections, as bacteria can easily enter the middle ear. If you suffer from recurrent infections that don't respond to medical treatment, surgery to repair the eardrum may be necessary.

  • Persistent Perforation: If a perforation does not heal on its own after several months or if it causes ongoing problems, myringoplasty may be recommended to promote healing and prevent further complications.

  • When protection from Water and Debris is needed: A perforated eardrum may allow water, dust, and debris to enter the middle ear, potentially leading to infections and discomfort. This is more likely to be needed if you want to swim, dive or trying to keep the ear dry is not effective. Closing the hole with myringoplasty helps protect the ear from external contaminants.

What is the success rate?

  • For small holes, the success rate is very high. For bigger ones, or for patients who are smokers or are on steroids, it is lesser.

What does Myringoplasty involve?
Myringoplasty is typically performed as a day case procedure under general anaesthesia, depending on the patient's condition and the complexity of the surgery.

 

The surgery is generally straightforward and involves the following steps:

  • Preoperative Evaluation: Before surgery, Dr Fragkiadakis will do a thorough evaluation, which will include a hearing test (audiometry from a certified audiologist) and sometimes imaging studies (such as a CT scan) to assess the size and location of the perforation and to ensure there are no other underlying issues in the middle ear.

  • Pre anaesthetic assessment: You are going to have a preoperative assessment in the hospital, to ensure you are fit for a general anaesthetic. You are going to meet your anaesthetist on the day and discuss about the anaesthetic.

  • Surgery: Dr Fragkiadakis will access the eardrum through the ear canal using an endoscope so to avoid as many incisions as possible. Occasionally, for more complex cases an incision behind the ear, might be needed. The material used to seal the eardrum hole is called graft. It is usually manmade and taken from the cartilage in front of the ear. It is carefully placed over the perforation in the eardrum. This graft will cover the hole and allow the eardrum to heal. Once the graft is in place, the wound is closed with dissolvable packing, the skin incision with absorbable sutures, and a sterile dressing may be applied to the ear. The graft typically integrates with the eardrum over time, allowing the eardrum to heal and regain its normal function.

  • Postoperative Care: After the procedure, you will be monitored for a short period and typically can go home the same day. The ear may be protected with a temporary bandage or a cotton wick to keep the ear dry and prevent infection.

Are there any other alternative than surgery?

  • If the hole of the ear drum is small, you don’t get any infections or ear discharge or the hearing loss does not need any further treatment, you might decide not to have surgery.

  • You need to try to keep your ear dry when showering, bathing or swimming, with use of a cotton plug covered with Vaseline or swimming plugs.

  • If you get an infection or ear discharge, it will need cleaning under a microscope and possible treatment with antibiotic drops or sprays.

  • If you have hearing loss affecting your life, you might need a hearing aid fitted.

Risks and Potential Complications
As with any surgery, myringoplasty carries some risks. However, complications are uncommon. Some potential risks include:

  • Infection: Although infection is uncommon, there is always a risk of developing an infection at the surgical site. Postoperative antibiotics may be prescribed to help prevent this. If it happens, you will experience worsening pain post operatively. In this case you need assessment by Dr Fragkiadakis

  • Bleeding: This is rather uncommon, although you might notice a small leak in the first few post operative days. It usually resolves on it’s own.

  • Hearing Loss: While the goal of myringoplasty is to improve hearing or keep it stable, there is a small risk that the surgery may not fully restore hearing, especially if the middle ear structures have been damaged. Very rarely, severe deafness can happen, when the inner ear is damaged.

  • Graft Failure: The graft used to repair the eardrum may not fully take or heal correctly, leading to graft failure. In some cases, a second surgery may be needed.

  • Tinnitus: Some patients may experience tinnitus (ringing in the ear) after the surgery, though this usually resolves over time. Immediately postoperatively, you will experience some noises in the operated ear, due to the packing, but this should resolve within a few weeks. Persisting tinnitus is rare.

  • Vertigo or Dizziness: Occasionally, patients may experience dizziness or balance issues after the surgery, particularly if the inner ear is affected during the procedure. This is usually temporary and resolves over time and very rarely is permanent.

  • Altered taste: One of the nerve responsible for taste, might be damaged during the operation, leaving you with a metallic taste. This usually recovers with time, but can be permanent in some occasions.

  • Residual Perforation: In some cases, the perforation may not heal completely, requiring additional treatment.

  • Facial weakness: The nerve moving the muscles of the face is called facial nerve and runs through the ear. There is a very small chance it being damaged during surgery. This results in weakness of the facial muscles, meaning that you might it find difficult to close your eye, smile or raise the eyebrows. This could be partial or complete, temporary or permanent. It can happen immediately after surgery or with some delay within the first few days. Recovery can be complete or partial.

  • Risks relating to the general anaesthetic: For more info for anaesthetic risks, you can check this link.

What is the recovery like after myringoplasty?
Most patients recover well after myringoplasty, although it is important to follow Dr Fragkiadakis’ s instructions for proper healing. Here’s what to expect during recovery:

  • Immediate Postoperative period: After surgery, you may experience mild discomfort, which can typically be managed with paracetamol. After you have eaten, been to the toilet, mobilised and manage with the post operative pain, you will be allowed to go home. You will not be allowed to drive for 48 hours following a general anaesthetic. You will need to keep the ear dry for several weeks. Avoid getting water in the ear during showers or swimming, as this can interfere with healing and increase the risk of infection. The packing can sometimes fall out or you might see a small amount of bleeding.

  • Follow-Up Appointments: A follow-up appointment will be scheduled about two to three weeks after surgery to check the healing process and ensure there are no signs of complications. You might need additional follow-up visits to monitor the eardrum’s healing and the success of the graft. If you have any concerns, please do not hesitate to expedite the appointment.

  • Activity Restrictions: You will need to avoid strenuous activities or heavy lifting for several weeks after the surgery to reduce pressure on the ear and support the healing process. If you need to sneeze, do not try to hold it. Instead open the mouth and expel the pressure through the mouth. It’s also important to avoid blowing your nose forcefully, as this can cause pressure changes in the middle ear and disrupt the repair.

  • Hearing Recovery: It may take a few weeks to a few months for the full benefits of the surgery to become apparent. Some patients notice an improvement in hearing almost immediately, while others may need additional time for the eardrum to fully heal and the hearing to stabilize.

  • Postoperative Medications: If an infection is suspected, a course of antibiotics may be prescribed. Pain relief medications like paracetamol may also be needed to be taken regularly for the first few days.

  • Sick note/off work: You will be provided with a sick note if necessary. Usually, one is given for two weeks if needed.

Further links for information
Myringoplasty - Patching a hole in the ear drum
If you have any further queries, do not hesitate to make contact at contact@entgeorge.com or book an appointment.

If you have any further queries call 02087207499 or email contact@entgeorge.com

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