Tympanoplasty

About tympanoplasty

A tympanoplasty is a procedure to repair an unhealthy eardrum. It often involves a repair to the hearing bones in your middle ear. 

This repair prevents your eardrum from wearing down your hearing bones (which can cause a loss of hearing).  

You can also develop a condition called cholesteatoma (a build-up of dead cells) in your middle ear.  This can cause an unpleasant-smelling discharge and hearing loss.

Alternative treatment

Surgery is the only way for us to repair an unhealthy eardrum.

You can use regular cleaning and antibiotics to help control unpleasant-smelling discharge or infection. This does not stop the complications caused by an unhealthy eardrum.

If you decide against the procedure

If you decide against the procedure, the problem is likely to get worse, causing damage to the bones in and near your ear.

Cholesteatoma (build-up of dead cells) can cause serious complications such as hearing loss, facial weakness and dizziness.

In rare cases it can also lead to brain abscess (build-up of pus), meningitis (infection of the membrane around the brain and spinal cord), mastoiditis (bone infection) or neck abscess.  

Preparing for the procedure

To prepare for the procedure, do the following.

• Try to quit smoking. This may reduce your risk of developing complications after the procedure. 
• Maintain a healthy weight. If you are overweight, you have a higher risk of developing complications.
• Take regular exercise. This will help to prepare, recover and improve your health long-term. Ask your GP or healthcare team for advice on a suitable exercise plan.
• Speak to the healthcare team about updating any vaccinations to reduce your risk of serious illness while you recover. 

About the procedure

We only carry out the procedure when you have given us your written consent.

We usually perform the procedure under a general anaesthetic (while you are asleep), but sometimes we use a local anaesthetic. Your anaesthetist will discuss the options with you.

We may also give you injections of local anaesthetic to help with the pain after the procedure.

Your surgeon uses a graft (piece of tissue) to repair your eardrum. They will take the graft from either in front or behind your ear. Usually they use the covering layer of a muscle which is above your ear. Sometimes they use some cartilage from around your ear. This will not change the shape of your ear.

Your surgeon will cut away the part of your eardrum that is unhealthy. To do this, they may need to drill away some of the bone around your eardrum. They may need to remove some bone. In this situation they will reconstruct the bone by reshaping existing bone or by using an implant.

The procedure usually takes 60 to 90 minutes.

After the procedure

After the procedure you can expect the following.

• We will transfer to the recovery area and then to the ward. You may be able to go home the same day. However, your doctor may recommend that you stay a little longer.
• If we have used a head bandage, we may remove it before you go home or we may give you instructions on how to remove it.
• Protect your ear from water using cotton wool and Vaseline.
• Do not swim until your surgeon has told you that the graft has worked. This will usually take about 6 weeks but can take longer.
• Your surgeon will tell you when you can return to normal activities. Most people are able to return to work after about 2 weeks.
• Your surgeon will tell you when it is safe for you to fly.

If you have been given sedation during your procedure, for the first 24 hours you must not:

• operate heavy machinery
• drive any vehicle
• undertake potentially dangerous activities (including cooking)
• consume alcohol
• sign legal documents.

Benefits and risks

Benefits

The aim is to repair your eardrum and stop any discharge from the ear. We may be able to improve your hearing at the same time.

Risks

During or shortly after surgery

Facial nerve injury (rare: fewer than 1 in 100). The facial nerve is the main nerve that controls movements of the face and is also involved in the sense of taste. Injury to this nerve can impact the use of muscles in the face, including leading to difficulty with closing the eye, difficulty chewing and facial droop. Paralysis can be partial or complete. It may occur immediately after surgery or have a delayed onset. Recovery can be complete or partial. 

In the days after surgery

Discomfort (common: more than 1 in 20). It is normal to have some discomfort, including pain, irritation, or stiffness, for a few days or weeks after treatment. We will discuss pain relief options with you.

Graft failure (common: more than 1 in 20). Graft failure means the graft that we use stops working. This may require revision surgery.

Bloodstained ear discharge (common: more than 1 in 20).  Small amounts of fluid can leak from the ear following surgery, and this can contain blood. It will usually settle after a few days.

Ear infection (common: more than 1 in 20). This may cause earache, a high temperature and sickness, and sometimes difficulty with hearing or balance. We may need to treat this with antibiotic drops in the ear.

Hearing loss (less common: fewer than 1 in 20). This is usually temporary but can persist long-term (although this is rare).

Tinnitus (less common: fewer than 1 in 20). Tinnitus describes the sensation of ringing or noise in the ear. This is usually temporary but can persist long-term (although this is rare).

Altered taste (rare: fewer than 1 in 100). The flavour of some foods or drinks may be different or reduced. This is usually temporary but can persist long-term (although this is rare). 

Unilateral (one side) deafness (rare: fewer than 1 in 100). This is loss of hearing in one ear, while the hearing in the other ear remains normal.

Vertigo (less common: fewer than 1 in 20). This is the sensation that you or the room around you is moving (often described as a spinning sensation). Symptoms can range from mild to severe and affect your ability to carry out usual activities.

In the months or years after surgery

Visible scar (common: more than 1 in 20). Usually scars fade and become paler over time, but do not completely disappear.

Occasionally abnormal scarring occurs, where the scar that forms is either larger or a different colour, or more uncomfortable than is typical. This can occur more often if a wound has taken a long time to heal, and in certain skin types.

Persistent eardrum perforation (less common: fewer than 1 in 20). This is a hole in the eardrum that is not healing.

Follow-up

Most people make a good recovery. We will check your ear after 2 to 3 weeks and if necessary, we will prescribe ear drops.

If the graft is successful, you are unlikely to develop ear infections and you will be able to swim and bathe as normal. Your hearing may improve but this depends on the damage to your hearing bones before the procedure.

Sometimes a patient needs a further procedure to remove excess eardrum material. Your surgeon will discuss this with you.