MYRINGOPLASTY
Myringoplasty- Repair of the eardrum
Myringoplasty. Eardrum repair. Tympanoplasty. Ear surgery.
Perforation of the ear drum can occur due to trauma or infection.
Middle ear infection (Otitis Media) quite often leads to a perforated ear drum.
A perforated ear drum causes hearing loss and is an open access for infections to travel to the middle ear from the external ear.
Frequent colds, ingress of water in the ear are two of the commonest causes for discharge from the ear.
Every time there is discharge from the ear the toxins released by the bacteria can enter the inner ear through permeable membranes and cause a sensorineural hearing loss which is a permanent kind of hearing loss.
It is therefore advised that a persistent perforation of the ear drum must be repaired surgically - a procedure called Myringoplasty (Myringo-eardrum, Plasty- repair).

Approaches for Myringoplasty
- Per Meatal – for very small perforations, wide ear canal, or if done Endoscopically
- Post Aural – the most common approach- from behind the ear - in the groove where the pinna is attached.
- Endaural- For posterior perforations or if associated with a mastoidectomy.

Graft Material used for Myringoplasty
- Paper patch, Fat – for pin hole perforations – very uncertain results
- Temporalis Fascia – Dense membrane above the ear – probably the most commonly used tissue for eardrum repair
- Tragal Perichondrium- from the Tragus (cartilage in front of the ear).
- Composite graft – combined cartilage and Tragal perichondrium – specially in case of retraction pockets or where the eardrum is being pulled in on account of negative pressure.

Procedure
In a typical Myringoplasty done by the post aural approach –
- Hair around the operated ear is shaved for access and for dressing purposes
- The operated part is cleaned and sterilized with Povidone Iodine
- 2 % Xylocaine with adrenaline is infiltrated
- A skin incision is made in the groove behind the er and skin flaps lifted
- Temporalis Fascia graft is harvested
- Edges of the perforation are freshened
- Tympanomeatal flap is elevated
- Graft is placed in the ear over self absorbing gelatin sponge in the middle ear
- Ear pack is applied
- Wound is closed – usually subcuticular sutures are applied
- Mastoid bandage is applied

Post Operative Period
The mastoid bandage is usually removed on day 5
Aural pack is removed 10-14 days later
Neomembrane formation typically takes about 4-6 weeks

Care during Post Op period
- Ear must be kept dry
- Treat a cold immediately
- Avoid air travel for about 3-4 weeks
- Inform doctor immediately in case of Facial weakness/ Paralysis including incomplete eye closure, giddiness, Tinnitus (buzzing in ears), Nausea / Vomiting
- Do not blow your nose vigorously

Anaesthesia for Myringoplasty
- Local Anaesthesia – Injection of Local Anaesthetic into the ear and surrounding tissues.
- MAC – Monitored Anaesthesia care – Patient is not intubated, the Anaesthetist gives sedation and pain medication via an Intra Venous route.
- General Anaesthesia – full GA.
The decision is taken depending upon the patient's and the surgeon's preference as well as on other medical factors.

Complication of Myringoplasty
Though generally safe and well tolerated there are some complications of the procedure- -
- Graft rejection
- Residual perforation
- Facial nerve damage
- Hearing loss
- Tinnitus
- Giddiness etc


There is no other cure for a persistent perforation of the ear drum- it can only be repaired surgically.

If you have a perforated ear drum please do not hesitate to call us at - 9871150032 or 9205585295 for an appointment.

This Video and the accompanying information is not a substitute for a medical consultation.
Kindly consult your Doctor for your medical queries.
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