Tympanoplasty
Surgical Repair of the Perforated Eardrum
Tympanoplasty literally means reconstruction of the middle ear. The procedure can be performed either through the ear canal or via an incision behind the ear canal, and is dictated by one’s ear anatomy and the pathology to be addressed. Tympanoplasty can encompass many different procedures. Sometimes tympanoplasty is as simple as repairing a small hole in the ear drum or as complicated as reconstructing the whole hearing mechanism including the ear drum and the ear bones. The simplest type of tympanoplasty involves repair of the ear drum. The most common material used for this is fascia or the covering of the temporalis muscle. In addition to repairing the ear drum, often, it is necessary to repair one of the three ear bones (ossicles) in the middle ear during tympanoplasty. These bones can be dislocated, eroded, fractured, or fixated, which make it inefficient and difficult for the sound to be transmitted to the inner ear. Various prostheses are available to reconstruct the bones. When ear canal is eroded, ear cartilage is employed to reconstruct it. There may be situations where ear canal may need to be covered with skin, in which case, a full-thickness skin graft, usually harvested from behind the ear, is used. If the patient suffers from chronic Eustachian tube dysfunction, a ventilation tube may be inserted at the end of the procedure.
Not uncommonly, because the mastoid bone, located behind the ear, is connected to the middle ear, it may be involved with the same infection or disease as the middle ear. In that case, the mastoid bone will be “cleaned” out as well ( mastoidectomy).
Most cases of tympanoplasty are done with a general anesthesia as an outpatient. If an incision is necessary behind the ear, a large wrap bandage around the head will be placed at the time of surgery .This can be taken off the next day. If the incision is made in the ear canal a cotton ball will be placed in the ear with a band aid. It is very rare that the patient requires an overnight hospitalization. There will be some discomfort and soreness in the ear but this is usually not severe. Minor analgesics are usually all that is necessary. However, narcotics are usually provided in the immediate post operative course as necessary. It is important that one not take any aspirin, Advil, Nuprin, Aleve, or any of these types of medicines prior to the operation for seven days as they cause bleeding. Tylenol is fine as it does not cause any bleeding.
Please be advised that in most cases of tympanoplasty, prior to the conclusion of the procedure, the middle ear and the ear canal are packed with a material that helps to heal properly, so that one’s hearing is expected to be muffled. The packing material in the ear canal will be removed on the 2 week-postop visit. About 4 weeks after surgery, the packing that is on the inside of the ear drum will start dissolving and the hearing generally starts improving at that time. Maximum hearing gain can usually be expected within about four months. It is important to care for the ear properly in the post operative period. Do not get the ear wet in the first week after surgery. After that, it is okay to wash behind the ear and get the area behind the ear wet. However, water should still not go in the ear canal for six weeks. When washing the hair, it is important to place a cotton ball in the ear canal with tape or Vaseline over the cotton ball.
There are some risks and complications involved in any surgery. Those with tympanoplasty with or without mastoidectomy are ones common to any ear surgery due to the anatomy of the ear. There is a chance, albeit rare, that the hearing can be worse or even total hearing lost with any ear surgery. It is not uncommon to get a little dizzy after ear surgery in the first 24 hours. However, this usually resolves after about 24 hours. It is very rare for dizziness to persist. It is not uncommon to have some taste disturbance after tympanoplasty. This usually involves a metallic taste that persists for two or three weeks and then resolves. Rarely does this persist. It is very uncommon to have injury to the nerve that moves the face, although this nerve does go through the ear. In rare cases is this nerve injured and can cause paralysis of the face necessitating further surgery .In some cases there are defects in the bone that separates the brain from the ear. This can lead to a leak of spinal fluid or infection of the brain.
After Surgery Instruction
DO NOT GET WATER IN THE EARS! This is very important because it may cause infections.
You may take shower, but do so with the ear plugged with cotton balls coated with vasoline until cleared by Dr. Kim.
Please do not strain, blow nose, or lift heavy things for about 2 weeks. Cough or sneeze with mouth open.
You may resume pre-op diet as tolerated.
Expected:
discharge for 1-3 weeks
mild-moderate pain
mild dizziness, nausea and vomiting, and mild fever for few days.
Contact Dr. Kim if the following conditions arise:
fever >101.5
Bleeding
Nausea and vomiting lasting greater than 2days.
It is extremely important that you come back for routine visits.
Usually, you should be seen within three weeks following the surgery. Please call the office for an appointment.
You may return to school or work when you feel up to it- usually in 1-2 week
