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.
RISKS OF MYRINGOPLASTY
- 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.