Myringoplasty is the closure of the perforation of pars tensa of the tympanic membrane. When myringoplasty is combined with ossicular reconstruction, it is called tympanoplasty. The operation is performed with the patient supine and face turned to one side. The graft material most commonly used for the surgery is temporalis fascia. The tragal cartilage and tragal perichondrium are also used as the graft by some surgeons.
Myringoplasty restores hearing loss in certain cases of tinnitus. The chances of re-infection and persistent discharge is less after surgery. Myringoplasty should not be performed if there is active discharge from the middle ear, or if the patient has uncontrolled nasal allergy, or when the other ear is dead and in children less than 3 years of age. Myringoplasty is often done under general anesthesia, but it can be done under local anesthesia also.
When does a child need a myringoplasty?
Your child’s primary care provider can determine whether your child has a hole in his eardrum by using an instrument called an otoscope. If your primary care provider has any concerns about the hole not healing or being associated with repeat ear infections or hearing loss, the primary care provider will refer your child to an otolaryngologist.
To determine if your child is a good candidate for myringoplasty, the otolaryngologist will do a thorough exam of your child’s ear and conduct hearing tests. Based on the results of this evaluation, myringoplasty may be recommended.
In general, your child may be a candidate if he:
- Has a hole in his eardrum that hasn’t healed within three months
- Has repeat ear infections, especially if these repeat infections caused the hole in the first place. That might signal a Eustachian tube problem that prevents the hole from healing on its own.
- Has a hole in the center of his eardrum
- Wants to swim without waterproofing his ear. Water entering the hole can lead to infections.
Before myringoplasty
A few weeks before the operation, you will be contacted by the hospital with a date and time for the operation. You will be sent information about when to stop eating and what to bring to hospital. You may be asked to attend a pre-admission clinic before your operation so that your doctor can decide if you need any other preparation for the operation. You will have a chance to further discuss the risks, and then will be asked to sign a consent form. If you smoke, you should aim to stop at least 24 hours before your operation. If you decide you don’t want the operation, you should contact us and your GP.
During the myringoplasty procedure
Myringoplasty usually takes between 10 and 30 minutes. Tympanoplasty usually takes from 2 to 3 hours. Recovery from general anesthetic can take several hours. Your child might be prescribed medications after the surgery.
Your child will lie on the table with his face to one side. The surgeon will use general anesthesia in this simple procedure that usually lasts between 10 and 30 minutes. During myringoplasty, the surgeon will:
- Enter the ear either through an incision behind the ear or through the ear canal, depending on the size and location of the hole and the size of your child’s ear canal
- Use an instrument to “freshen” the edge of the hole which triggers the body’s own natural healing process
- Place a graft made of tissue from beneath his skin or a gel foam or paper-like material
- Fill your child’s ear with cotton packing that will stay in his ear for about a week
- Apply a bandage across the outside of the ear to protect his ear canal
Myringoplasty recovery
After the myringoplasty procedure, your child may feel groggy or even nauseous from the anesthesia. He can recover with his parents at his side in the post-operative unit. He’ll likely feel better within a few hours, or by the time he goes home, which is usually on the day of surgery.
Your child will be prescribed antibiotic ear drops to prevent the risk of infection; the drops go into the ear canal, requiring a momentary removal of the packing.
Once home, your child should rest. He can eat bland foods and drink clear liquids as he feels up to it. He can return to normal activities at his own pace, usually within a couple of days. Sneezing with his mouth closed and nose blowing are to be avoided for several weeks. Your child will also have to keep his ear dry, so showers are to be avoided until the doctor gives the okay. Your child will also have to avoid sports for several weeks; swimming may be discouraged for several weeks.
He might have mild ear pain and soreness for the first few days, but the discomfort should pass within five days. Acetaminophen can help, if the doctor prescribes it. He may also experience popping, clicking or other sounds in his ear, which are normal and will go away within a few days.
Ear drainage can be cleaned outside the ear bandage for the first several days. Your doctor or nurse will give you instructions on how this is to be done. Nothing should be put into the ear canal except the appropriate amount of antibiotic ear drops.
At the follow-up visit, usually four to six weeks after surgery, your child’s doctor may remove the packing. Be careful not to touch the packing until then. There are no stitches to be removed at the follow-up visit; they’ll dissolve on their own.
What is the advantage of myringoplasty procedure?
- Restores the hearing loss and in some cases, tinnitus.
- Checks the re-infection from external auditory canal and eustachian tube.
- Checks aeroallergens reaching the exposed middle ear mucosa, leading to persistent ear discharge.
The complications of myringoplasty procedure
There are some risks that you must be aware of before giving consent to this treatment. These potential complications are rare. You should consult your surgeon about the likelihood of problems in your case.
- Taste disturbance: The taste nerve runs close to the eardrum and may occasionally be damaged. This can cause an abnormal taste on one side of the tongue. This is usually temporary but occasionally it can be permanent.
- Dizziness: Dizziness is common for a few hours following surgery. On rare occasions, dizziness is prolonged.
- Hearing loss: In a very small number of patients, severe deafness can happen if the inner ear is damaged.
- Tinnitus: Sometimes the patient may notice noise in the ear, in particular if the hearing loss worsens.
- Facial Paralysis: The nerve for the muscle of the face runs through the ear. Therefore, there is a slight chance of a facial paralysis. The facial paralysis affects the movement of the facial muscles for closing of the eye, making a smile and raising the forehead. The paralysis could be partial or complete. It may occur immediately after surgery or have a delayed onset. Recovery can be complete or partial.
- Reaction to ear dressings: Occasionally the ear may develop an allergic reaction to the dressings in the ear canal. If this happens, the pinna (outer ear) may become swollen and red. You should consult your surgeon so that he can remove the dressing from your ear. The allergic reaction should settle down after a few days.
What improvements can I expect from a myringoplasty?
This varies a lot from person to person and depends on what symptoms you have to start with. Possible benefits include:
– you may get a mild improvement in your hearing.
– you are less likely to get middle ear infections when you get your ears wet
– less ear discharge
Differences between myringoplasty and tympanoplasty?
A type 1 tympanoplasty is synonymous to myringoplasty. Type 2 involves repair of the tympanic membrane and middle ear in spite of slight defects in the middle ear ossicles. The resulting middle ear will only consist of the Eustachian tube and hypotympanum. Type 5 is a repair involving a fixed stapes footplate.
Facts about tympanoplasty and myringoplasty
- Tympanoplasty (tim-PAN-oh-plas-tee) and myringoplasty (mer-RING-go-plas-tee) are surgical procedures to repair a hole in a child’s eardrum (tympanic membrane).
- Tympanoplasty and myringoplasty are outpatient surgeries that will be done at the Same Day Surgery Center at Children’s Hospital in Lawrenceville or at Children’s North surgery center.
- Tympanoplasty and myringoplasty both require general anesthesia (an-es-THEEZ-ya) to make your child sleep during the surgery.
- When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery.
- Myringoplasty usually takes between 10 and 30 minutes.
- Tympanoplasty usually takes from 2 to 3 hours.
- Recovery from general anesthetic can take several hours.
- Your child might be prescribed medications after the surgery.