Patch Tympanoplasty is the most minor of the procedures. It is performed in the office in adults and under anesthesia in children. The edges of the hole are irritated with an instrument, and a biologic tissue paper patch is placed over the hole and held on with a drop of blood from the irritation
Fat Tympanoplasty is another minor procedure that can be performed in the office. The ear lobe is frozen, a small amount of fat is removed, the eardrum is irritated and the fat is placed through the hole. The earlobe is sutured.
Medial Tympanoplasty is performed in the operating room under local or general anesthesia. It can sometimes be performed working through the ear canal, but is usually performed via an incision behind the ear. Incisions are made in the ear canal and the remnant of the eardrum is lifted up. The ear canal may be widened. A tissue graft from the ear muscle (fascia) or cartilage is obtained and is slid under the eardrum. Packing is placed in the middle ear and ear canal to hold the graft and drum against each other to heal.
Lateral Tympanoplasty is performed under general anesthesia in ears with large holes, holes in the front part of the eardrum or when previous surgeries have failed to close a perforation. It is performed through an incision behind the ear and the ear canal is widened. Some or most of the original eardrum is removed. A fascia graft is harvested, and used to create a new eardrum. A small skin graft is often taken from behind the outer ear and used to line the surface of the widened ear canal to get the ear canal to heal quickly.