Myringoplasty - Indications, Procedure, Benefits, and Complications

Creator: Dr. Osheen Kour
Published: 2023-04-27T17:00:13

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Myringoplasty is the surgical procedure to repair the ruptured eardrum's hole or perforation. Read to know more about it.

Written by

Dr. Osheen Kour

Medically reviewed by

Dr. Laxmi Narasimha G

April 27, 2023

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Contents

What Are the Indications for Myringoplasty?
What Are the Symptoms of Eardrum Perforation?
What Are the Various Causes of Eardrum Perforation?
What Are the Various Types of Grafts Used in Myringoplasty?
What Is the Procedure for Myringoplasty?
What Happens Post-Myringoplasty?
What Are the Benefits of Myringoplasty?
What Are the Complications Associated With Myringoplasty?

Introduction

Myringoplasty is a surgical procedure for a ruptured eardrum and is done by placing a graft over the hole or perforation in the eardrum. The tympanic membrane or eardrum is a dime-sized and fragile tissue between the middle and the outer ear. The eardrum helps us to hear the sound waves by vibrating. Unfortunately, the eardrum in the ear can get ruptured for various reasons, such as head trauma, ear infections, loud noise, and sticking objects in the ear. Therefore, myringoplasty helps to repair the hole or perforation in the eardrum and can minimize the risk of various health problems such as permanent hearing loss, mastoiditis or infection of the mastoid bone behind the ear, and vertigo.

This eardrum surgery is common in children and sometimes needed by adults too. Myringoplasty can be unilateral (in one ear) or bilateral (in both ears) and is performed by the ENT specialist or otolaryngologist.

What Are the Indications for Myringoplasty?

A person needs myringoplasty in the following cases:

If they have a chronic ear infection.
If ear infections are recurring.
A ruptured eardrum has led to hearing loss.
Perforated eardrum due to some trauma.
Ruptured eardrum that has not healed within three months.

What Are the Symptoms of Eardrum Perforation?

The symptoms of eardrum perforations are as follows:

Pain in the ear.
Sudden hearing loss or hearing is not clear or is muffled.
Fluid, blood, or pus-filled drainage from the ear.
Buzzing or ringing in the ear (tinnitus).
Itching in the ear.
High temperature.

What Are the Various Causes of Eardrum Perforation?

Change in pressure while driving at high altitudes, flying through an airplane, forceful, direct impact on the ear, shock waves, or scuba diving.
Ear infections can cause an accumulation of fluid in the ear that creates pressure and causes an eardrum rupture.
Trauma, injury, or a direct hit on the ear can also damage the eardrum.

What Are the Various Types of Grafts Used in Myringoplasty?

The various types of grafts used in myringoplasty are as follows:

Temporalis Fascia: It is a strong connective tissue layer covering the temporalis muscle. The surgeon can harvest the tissues from this muscle to fix the hole or perforation in the eardrum.
Cartilage: This graft is also known as cartilage myringoplasty, in which a surgeon takes a small cartilage from our body to patch the eardrum’s hole.
Perichondrium: The elastic cartilage in the ear is covered by a layer of connective tissues called the perichondrium. The surgeon also harvests this connective tissue for myringoplasty procedures to use as a graft.
Synthetic Materials: In this procedure, surgeons use synthetic materials such as surgical paper and gel foams as grafts in myringoplasty surgery. The method is also known as paper patch myringoplasty.
Fat: In this graft, the fat tissues from the earlobes are used to repair the ruptured eardrum. The procedure is also called fat graft myringoplasty.

What Is the Procedure for Myringoplasty?

The Myringoplasty procedure is done under general or local anesthesia and usually takes 30 to 90 minutes to complete. The surgery is performed in the following way:

The surgeon accesses the eardrum via the ear canal by making a small incision behind the ear. The incision is made according to the size and location of the perforation or hole in the eardrum and the ear canal's size.
The tissues around the area or hole are roughed and prepared to attach the graft.
The graft or tissues harvested from other body parts are taken to patch or fix the perforation in the eardrum. If the surgeon uses synthetic grafts, this step is skipped.
The graft is then placed over the perforation or hole in the eardrum, and the ear is filled with cotton packing material for at least a week.
At last, the bandage is applied outside the ear to protect the ear canal.

What Happens Post-Myringoplasty?

A child or person may feel nauseous post-myringoplasty due to anesthesia. However, the signs and symptoms usually resolve within a few hours, and the child can return home the same day. The doctor prescribes antibiotics and gives instructions to patients or attendants. The instructions may include eating bland food, avoiding nose blowing, sneezing with a closed mouth, and keeping the ear dry for several days.

The person may feel mild pain, clicking sounds, soreness, and popping sounds in the ear for a few days, which will improve with time. The doctor usually removes the ear packing and bandage after four to six weeks post-surgery.

Children usually recover fast from myringoplasty, but the doctor should be consulted immediately if any unusual symptoms (fever, tinnitus, nausea, pain, breathing difficulty, etc.) develop.

What Are the Benefits of Myringoplasty?

The benefits of myringoplasty include:

The surgery has about a 94 % success rate.
People undergoing myringoplasty surgery have improved hearing ability.
The success rate of myringoplasty is the same in both children and adults.
The risk of language delays caused due to hearing loss in children can also be minimized with myringoplasty.

What Are the Complications Associated With Myringoplasty?

The complications associated with myringoplasty are infrequent but can cause various risks. These include:

Dizziness.
Infection.
Hearing loss.
Tinnitus or ringing sound in the ears.
Recurring holes or perforations in the eardrum.
Myringoplasty or graft failure can cause symptoms like infection, severe bleeding, and taste distortion.

Conclusion

Myringoplasty is a standard surgical procedure to repair holes in the eardrum and can be used for both children and adults. The doctor initially opts for conservative treatment methods to treat the eardrum. But if the ruptured eardrum does not heal within three months, myringoplasty is recommended. A person usually recovers within two weeks after the surgery, and the doctor plans the patient’s follow-ups after four to six weeks post-surgery. Therefore, a person experiencing any symptoms that indicate a rupture of the eardrum or has hearing difficulties should consult the doctor immediately to avoid permanent hearing loss. Also, a person should follow all the pre and post-operative measures suggested by the doctor to avoid any complications and risks in the long term.

Frequently Asked Questions

1. What Precautions Are Necessary Following Myringoplasty?

After myringoplasty, avoiding activities that may put undue pressure on the ear or introduce infection is essential. It is advisable to steer clear of swimming or any water exposure and refrain from activities that involve sudden changes in pressure, such as flying or diving.
Adhere strictly to the prescribed medication regimen provided by the healthcare provider. Refrain from removing dressing or bandages unless necessary for applying antibiotic ear drops, with instructions on proper administration given by the provider.
Prioritize rest and minimize activity. When sneezing, keep the mouth closed, and avoid blowing the nose. Delay showering until the surgeon approves; however, baths are acceptable, ensuring the ear is packed with cotton to prevent water from entering the ear canal.

2. When Can Improvements in Hearing Be Expected After Myringoplasty?

The timeline for hearing improvement after myringoplasty varies among individuals. While some may experience improvements relatively quickly, others may require several weeks to notice a significant difference. Factors influencing the duration include the extent of the initial hearing loss, the procedure's success, and individual healing rates. It is common for gradual improvements to occur over the weeks and months following the surgery as the ear heals.

3. When Can Improvements in Hearing Be Expected After Myringoplasty?

The timeline for hearing improvement after myringoplasty varies among individuals. While some may experience improvements relatively quickly, others may require several weeks to notice a significant difference. Factors influencing the duration include the extent of the initial hearing loss, the procedure's success, and individual healing rates. It is common for gradual improvements to occur over the weeks and months following the surgery as the ear heals.

4. What Precautions Should Be Taken Into Consideration for Myringoplasty?

Notify the doctor regarding any existing medical conditions. Before the procedure, discuss relevant circumstances with the doctor, including:
- History of allergies or reactions to medications, drugs, or food.
- Previous instances of bleeding or clotting disorders.
- Current use of medications (such as Aspirin, Clopidogrel, Warfarin, and Rivaroxaban) or supplements that possess blood-thinning effects. These substances can impact blood clotting and heighten the risk of bleeding. The doctor will provide guidance if one is taking any of these.
- Occurrence of an illness within the two weeks leading up to the scheduled surgery.

5. Are There Any Restrictions or Guidelines After Myringotomy?

Following myringotomy, it is crucial to avoid exposing the ear to water and avoid activities that might introduce dirt or bacteria into the ear canal. Patients are generally advised against flying or engaging in activities with rapid pressure changes, as these can affect the healing process. Avoid heavy lifting or nose blowing for three days post-operation. Take rest and limit physical activity. When sneezing, ensure the mouth remains closed, and refrain from blowing the nose.

6. What Is the Success Rate of Myringoplasty?

The success of myringoplasty depends on various factors, including the individual's overall health, the size and location of the perforation, and the surgeon's skill. In many cases, myringoplasty is a successful procedure, leading to the perforation's closure and hearing improvement. The success rates for this procedure can reach up to 94 percent. Similar success rates are observed in both children and adults.

7. What Are the Expected Outcomes Following Myringoplasty?

After myringoplasty, it is normal to experience some discomfort, temporary hearing changes, and drainage from the ear. Following postoperative care instructions is crucial for optimal healing. The ear may take some time to recover fully, and gradual improvements in hearing and overall well-being can be expected over the weeks and months following the surgery. Individuals who have undergone myringoplasty commonly note an improvement in their hearing. For young children, myringoplasty can reduce the risk of language delays associated with hearing loss.

8. Does Myringoplasty Provide a Permanent Solution?

Myringoplasty aims to provide a permanent solution by repairing the eardrum. Once the procedure is successful, the closure of the perforation is typically permanent. In many cases, myringoplasty can effectively close the perforation and restore the integrity of the eardrum, leading to improved hearing and the prevention of recurrent ear infections. However, the permanence of the results is only guaranteed for some patients. Small perforations generally have a higher success rate than larger ones, and the success of the surgery may also be influenced by factors such as the surgeon's skill and others. While myringoplasty is considered a valuable and often successful intervention, patients must diligently follow post-operative care instructions.

9. Which Type of Tissue Is Employed in Myringoplasty?

Various types of tissue have been used to fix a hole in the eardrum. One commonly used tissue is temporalis fascia, with a success rate of around 93 percent to 97 percent in the main eardrum repair surgery. Recently, cartilage has been used for grafts because it is stiff and strong, which is believed to offer more stability and resistance to damage. However, some experts argue that these cartilage traits might negatively impact sound conduction.

10. What Is the Primary Objective of Myringoplasty?

Myringoplasty primarily aims to repair a perforated eardrum, restoring its integrity and function. Myringoplasty is performed to reconstruct the tympanic membrane, restore middle ear protection, and enhance hearing. This procedure addresses hearing loss, prevents recurrent ear infections, and protects the middle ear from foreign substances that could cause complications.

11. What Graft Material Is Commonly Used in Myringoplasty?

The commonly used graft materials for myringoplasty are mentioned below:
- Synthetic materials such as gel foam or surgical paper can be utilized by surgeons to patch the hole in a procedure known as paper patch myringoplasty.
- Temporalis fascia (a robust layer of connective tissue covering the temporalis muscle) can be harvested by the surgeon to patch the eardrum perforation.
- Perichondrium, a connective tissue layer covering elastic cartilage in the ear, may be collected by the surgeon for myringoplasty.
- In certain cases, fat tissue from the earlobe can be taken by surgeons to perform eardrum repair, a technique known as fat graft myringoplasty.
- Surgeons may opt to use a small piece of cartilage from the patient in a cartilage myringoplasty procedure to patch the eardrum hole.

12. Are There Specific Conditions That Make Myringotomy Inadvisable?

Myringotomy is not recommended in the presence of any indication of a middle ear mass or vascular anomaly, such as a glomus tumor, a high-riding jugular bulb, or displaced internal carotid artery. Prior head and neck radiotherapy is considered a relative contraindication to myringotomy. A healthcare provider can determine if myringotomy is a suitable and safe option based on an individual's health status.

13. Are There Specific Nerves That Require Careful Consideration in the Context of Myringotomy?

During the myringotomy, special care is taken to avoid the facial nerve. The facial nerve is a crucial nerve responsible for controlling facial muscles, and its proximity to the middle ear makes it susceptible to injury during the procedure. Damage to the facial nerve can result in facial weakness or paralysis, affecting various facial expressions and functions. Therefore, surgeons performing myringotomies exercise caution to prevent inadvertent damage to the facial nerve and subsequent complications.

14. What Is the Recommended Sleeping Position After Ear Surgery?

Maintain an elevated head position to alleviate swelling and discomfort. When sleeping at night, lie on your side with the ear facing upward, and try to avoid resting on the side where the surgery was performed. While it's essential not to engage in strenuous activities during recovery, prolonged bed rest is not advisable. Gentle activities such as getting out of bed and taking short walks around the house can benefit your well-being and contribute to a faster recovery.

15. Is Myringoplasty Considered a Safe Procedure?

Yes, myringoplasty surgery is generally safe and does not pose significant risks. Temporary numbness behind the ear may occur, especially if an incision is made in that area. The specific risks associated with the surgery depend on the underlying reason for the procedure and any pre-existing medical conditions. While some risks are exceedingly rare but severe, others are more common yet can be easily treated.

16. What Is the Intensity of Pain Experienced During Myringotomy?

Anesthesia is administered to prevent pain during surgery. Following the procedure, one might experience mild discomfort, and the doctor can prescribe pain medication or suggest over-the-counter pain relievers to help alleviate this pain. Lidocaine ear drops may be provided to reduce pain. During ear tube insertion, sensations like popping, pulsation, clicking, or minor pain may be perceived while burping, chewing, or yawning until the ear fully heals around the tubes.

Sources

Dr. Laxmi Narasimha G

Otolaryngology (E.N.T)

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