Tympanoplasty: Surgical Repair of the Perforated Eardrum

http://www.entcolumbia.org/tympan.htm
Perforations of the tympanic membrane (eardrum) due to acute infections often heal on their own, especially if the ruptures are small. Sometimes physicians may patch the eardrum using a cauterizing agent and a thin paper-like tissue; there are a number of effecti e in-office ariations on the patch procedure. !n some cases perforations fail to heal, howe er, e en with antibiotics or other medical treatments. Surgery to repair the perforated eardrum may be necessary to control infection, or it may be elected in order to protect the middle ear or to restore hearing. Tympanoplasty is a microsurgical procedure that uses a patient"s own tissues (autologous grafts), to reconstruct the tympanic membrane. #rafts may be taken from different areas, including (in order of most fre$uent use) loose connecti e tissue, temporalis fascia, tragal perichondrum, and the periosteum (%&'() *&' )+S%,!-+ +.%/ &0 1/+S+ !2 . 3&,) &, 45). 6eins are rarely used as they weaken o er time. .lloderm grafts (from synthetic materials) may be used if patients ha e had multiple pre ious surgeries and ha e limited graft a ailability. ,esults are about e$ual as those with autologous tissue. /omografts (tissue taken from other humans) or 7enografts (from animals) are sometimes a ailable, but in general they are less successful and less fre$uently used. 1he patient is usually placed under general anesthesia, although it may also be done under local anesthesia. 1he surgeon reconstructs the membrane either through the ear canal alone, or through the ear canal and through an incision behind the ear. 1he surgeon may use a laser to carefully remo e any scarring in the middle ear. !f the ossicles (small bones in the inner ear) ha e been damaged, the surgeon may also repair these, using either donor bones or prosthetic de ices (ossiculoplasty). 1ympanoplasty is usually a highly successful procedure, with o er 89: of patients reco ering without any complications. !n the hands of %olumbia"s highly trained surgeons, o er 8;: of patients" grafts take successfully. !f subse$uent operations are re$uired, these also are highly successful. -leeding and infection are ery small risks, as are chances of incomplete healing of the eardrum. )e elopment of cholesteatoma is another ery small risk and re$uires special treatment if it occurs. !f the ossicles ha e been damaged by in<ury or disease, hearing loss may be sustained despite surgery. .ppro7imately 4 to ; patients out of =999 will e7perience sustained hearing loss after tympanoplasty, according to research. .s with any surgery, the risks of anesthesia, such as reactions to the drugs and breathing difficulties, must be discussed with your physician. .fter surgery, patients may often lea e the hospital the same day. 1hey must keep the operated ear dry while bathing for two to three weeks, as directed. .ny hearing loss or tinnitus usually resol es in a few days. &ccasionally patients may lose the sense of taste on the operated side of the tongue; this also resol es within weeks.