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Hole in the Eardrum – Myringoplasty

Hole in the Eardrum - Myringoplasty

Details of the condition


  • This is the operation to repair a hole in the eardrum.
  • A hole in the eardrum may be caused by trauma, infection, prior grommet surgery or chronic blockage of the Eustachian tube.
  • It may initially present with pain, bleeding, discharge or hearing loss.
  • The patient will often present to the ENT surgeon during an infection, or after a recent trauma.
  • They may not be aware that there is a perforation.
  • After a history has been taken, any discharge that is present will be removed from the ear canal, usually with gentle microscopic suction.
  • If there is an active infection, a swab will be taken.
  • Hearing can be assessed clinically with tuning forks, and more formally with audiometry.


  • The treatment necessary will depend on the clinical presentation.
  • An acutely discharging perforation may require topical eardrops, with or without oral antibiotics.
  • Appropriate antimicrobials will be guided by the result of the ear swab, usually available several days later.
  • It is possible to achieve a dry, pain- free ear with non surgical treatment in the majority of cases, at which point the likelihood of spontaneous healing can be assessed.
  • If it is a new hole, there is a good chance that it will spontaneously heal, with a return of the ear to normal.
  • A small hole is more likely to heal than a large hole.
  • If the hole has persisted for months to years, an operation will be necessary to gain an in-tact eardrum.
  • An operation is considered when spontaneous closure seems unlikely, and there is a desire to gain a dry, waterproof ear, with possible improvement of the hearing.
  • It is not medically necessary to close an otherwise uncomplicated perforation, but can become desirable from a quality of life perspective.
  • If the perforation is not closed, water precautions such as an earplug when swimming will remain necessary.


  • This will require a general anaesthetic.
  • It may be a day procedure, or require an overnight stay, depending on the individual and the extent of surgery.
  • Smaller holes may be closed with a fat plug through the eardrum, or a cartilage button inserted to fill the perforation.
  • Larger perforations will require an underlay graft which may be performed through the ear canal, or with a cut behind the ear if the limit of the perforation is harder to see.
  • If the ear canal is very narrow, it may require widening with a drill (canalplasty).
  • Overall, the surgery will close the overwhelming majority of perforations.
  • If surgery is not successful at a first attempt, there is still a good chance of closing the hole with a subsequent procedure.


  • Pain is usually easy to manage. It is likely that return to work or school will be possible within a few days, but in a small number of people, up to 2 weeks may be required to recover.
  • Ideally heavy exertion/ straining should be avoided for 6 weeks, as should exposure to extreme pressure change (eg flying), or exposure to water.
  • The ear will feel blocked with reduced hearing for some weeks, and even for several months in some cases.
  • If stitches are used, they may be removed at 1 week.
  • In some cases the stitches are dissolving, and do not require removal.
  • The external part of the pack (a small ribbon gauze)is taken out at that stage, and the patient is commenced on antibiotic ear drops.
  • The deeper, dissolving pack (gelfoam) is then suctioned out at subsequent reviews in the following weeks.


  • Like all operations, there are risks associated.
  • At the time of planning an operation, Dr Smith will provide a printed handout form the college of surgeons, discuss issues surrounding surgery in detail, and answer any questions you may have.