Eardrum Repair - Types and Procedures

Introduction:

The eardrum is the thin membrane between the outer and middle ear, also known as the tympanic membrane. The tympanic membrane comprises thin connective tissue covered by the skin on the outer surface and mucosa on the inner surface. This membrane separates the outer ear from the middle ear. When the sound waves enter the ear and reach the tympanic membrane, they vibrate and transfer to the tiny bones in the middle ear. Then the vibrations are transferred from the middle ear bone to the inner ear.

The eardrum or middle ear damage can occur due to repeated ear infections, surgery, or trauma that has to be corrected with surgery.

What Is a Ruptured Eardrum?

A ruptured ear drum or perforated eardrum, or tympanic membrane perforation, is a hole in the membrane that separates the ear canal from the middle ear. The perforation can result in hearing loss and can also lead to various infections of the ear. The hole or perforation usually heals on its own after a few weeks, but in some cases, it requires surgical treatment.

What Are the Causes of a Ruptured Eardrum?

There can be various reasons for eardrum rupture, which include -

1. Middle Ear Infection (Otitis Media) - The middle ear infection may lead to the accumulation of fluids, which will cause an increase in pressure, leading to eardrum damage.

2. Barotrauma - This type of trauma is caused by the change in the pressure of the middle ear in association with the surrounding air pressure, usually during traveling to high altitude places.

3. Loud Sounds - A loud sound, such as an explosion or gunshot, can cause a tear or perforation in the eardrum.

4. Foreign Objects - Small objects or sharp objects such as hairpins can cause a puncture or tear in the eardrum.

5. Head Trauma - Injury of the head, such as skull base fracture, may cause damage to the middle and inner ear structures.

What Are the Symptoms of Eardrum Rupture?

The signs and symptoms of eardrum rupture include -

• Ear pain.

• Hearing loss.

• Tinnitus (ringing in the ear).

• Mucus-like discharge from the ear.

• Vertigo (spinning sensation).

• Nausea or vomiting.

How Are Ruptured Eardrums Diagnosed?

The healthcare provider or otolaryngologist (ENT - ear, nose, and throat specialist) will examine the inner ear with an otoscope (an instrument used to view the inside of the eardrum. Some hearing tests may also be conducted to evaluate hearing and eardrum motility. The tests may include the following -

• Tympanometry - This test evaluates the eardrum movement.

• Audiometry or Audiogram - These are hearing tests that will measure the ability of a person to hear soft sounds and different pitches.

What Is Eardrum Repair?

Eardrum repair refers to one or more surgical procedures to repair a perforation or other damage to the eardrum (tympanic membrane).

What Is the Purpose of Performing Eardrum Repair Surgery?

The eardrum is located between the outer ear and the middle ear. It moves when sound touches it. If the eardrum gets damaged or has a hole, hearing might get worse and ear infections can happen more often. Causes of eardrum holes can include severe ear infections, eustachian tube issues, foreign objects in the ear, ear tube surgery, and injury. If the eardrum has a small hole, a procedure called myringoplasty might help close it. Usually, doctors wait about six weeks after the hole forms before suggesting surgery.

Tympanoplasty might be needed in situations where,

• The eardrum has a bigger hole.

• There is a long-lasting ear infection that antibiotics do not fix.

• There is extra tissue around or behind the eardrum.

Ossicles (tiny bones behind the eardrum) may also be harmed by these problems. In such cases, an ossiculoplasty may be performed by a surgeon.

What Things Need to Be Done Before the Procedure?

1. Inform the healthcare professionals about:

• Any allergies to medicines, latex, tape, or skin cleansers.

• All medications taken, including herbs and vitamins purchased without a prescription.

2. Follow these instructions during the day of the procedure,

• Make sure to avoid eating or drinking anything as directed. This is especially crucial for infants, who should refrain from breastfeeding.

• Take any prescribed medications with just a small sip of water.

• If the child is feeling not well on the morning of the surgery, do not hesitate to contact the surgeon immediately; they may need to reschedule the procedure.

• Be sure to get to the hospital on time for the scheduled surgery.

What Are the Types of Eardrum Repair Procedures?

In the majority of cases, the procedure is done under general anesthesia. The surgeon will make an incision behind the ear or inside the canal. Depending upon the problem, the surgeon will perform the following procedures -

1. Myringoplasty - In this procedure, if the hole is small, the doctor may try to close it with the help of gel or thin paper-like tissue. It takes 15 to 30 minutes to perform and is done under local anesthesia.

2. Tympanoplasty - This procedure is performed if the perforation is large or if a chronic ear infection cannot be cured with simple antibiotics. So in this procedure, a laser will be used to remove excess tissue or scar tissue from the middle ear. In addition, a small piece of tissue from the vein or muscle sheath of the patient can be taken and grafted onto the eardrum to close the hole. This is performed under general anesthesia and takes around two to three hours. The surgeon can approach the membrane from the ear canal or can make a small incision behind the ear.

3. Ossiculoplasty - This procedure is done if the three bones, known as ossicles present in the middle ear, get damaged by an infection or trauma. It is also performed under general anesthesia, and the damaged bones are replaced with prosthetics or donor's bones.

What Is Done After the Procedure?

The patient may be discharged on the same day of surgery. To protect the ears after the surgery following things are done -

• Packing is placed inside the ear for the first few days, and a dressing is placed over the ear to cover it.

• The patient is asked to avoid getting water in the ear. Avoid taking showers or washing one's hair.

• Sneeze with one's mouth open and avoid blowing the nose.

• Avoid traveling, especially air travel, and avoid swimming.

• Gently clean the ear if there is any discharge on the outside of the ear.

• If there are stitches behind the ear, proper precaution has to be taken to prevent them from getting wet.

Moreover, the patient may feel pulsing, popping, or clicking sounds. The ear may feel full, and the patient may feel sharp shooting pain soon after the surgery.

What Are the Risks Associated With the Procedures?

The risks associated with general anesthesia and surgery, in general, include -

• Breathing problems.

• Reaction to drugs.

• Bleeding or blood clots.

• Infections.

Risks related to these eardrum repair procedures include -

• Damage to nerves such as the facial nerve.

• Damage to the small bones or ossicles in the middle ear leads to hearing loss.

• Incomplete healing of the perforation.

• Dizziness or vertigo.

• In rare cases, complete hearing loss.

How to Prevent Eardrum Damage?

Some of the following things should be taken into consideration to prevent any damage to the ears such as -

1. Getting treatment for middle ear infections as soon as possible.

2. Protecting the ears during flights.

3. Keeping the ears free of foreign objects.

4. Guarding the ears against loud noises.

Conclusion:

Eardrum repair procedures are very safe and commonly done procedures. These procedures have high success rates without any complications. In most cases, the pain, and symptoms are completely relieved with less hearing loss. The prognosis in these procedures is usually good. However, the prognosis might get compromised if the bones in the middle ear are also to be repaired along with the eardrum