Definition & Overview
Myringoplasty is the surgical closure of a perforation or hole in the tympanic membrane, the part of the ear commonly referred to as the eardrum. The perforation typically occurs in the greater part of the eardrum called the pars tensa. In some cases, this procedure is done concurrent to tympanoplasty, a procedure that requires ossicular reconstruction.
The eardrum, which is a thin membrane located between the ear canal and the middle ear, can be perforated as a result of infection, injury to the head, or chronic disorder of the Eustachian tube. Severe cases can lead to decreased hearing, fluid discharge, and associated pain.
In some cases, the perforation resolves itself after a short period as long as water is prevented from getting inside the ear to avoid the development of infection. However, persistent perforation often requires surgical intervention especially if it has a significant impact on the patient’s daily activities and there’s a risk of greater damage to surrounding ear parts.
Who Should Undergo and Expected Results
Myringoplasty is often recommended to patients suffering from persistent perforation of the eardrum particularly if the hole is large enough to cause decreased hearing.
It is also recommended for those diagnosed with chronic otitis media that led to fluid discharge and eventual eardrum perforation.
Some patients diagnosed with tinnitus may also be advised to undergo the procedure. Tinnitus is a condition characterised by the hearing of ringing or roaring sound when no external sound is present.
It is good to note that there are several conditions that could cause the delay of performing myringoplasty. If there is continued discharge from the middle ear or if the patient is suffering from nasal allergy, then surgical repair is postponed. Meanwhile, the procedure is not suitable for patients suffering from otitis externa or are experiencing deafness. It is also not indicated for children below three years old.
Myringoplasty is considered a safe procedure with high graft success rate. Most patients report improved hearing ability afterwards. Young children who underwent this procedure may avoid the further impact of hearing loss on language development.
How is the Procedure Performed?
The procedure is performed under general anaesthesia. Before the actual repair, the graft material needs to be harvested. The most common graft is the true temporalis fascia found near the surgical site. To start this process, the surgeon marks an identified area behind the ear and makes the incision. The graft material is then chosen and excised and any muscle or fat attached to the fascia is removed. The graft is then set aside for later use.
There are two types of techniques used to perform the procedure. First is the underlay technique that involves making an incision along the perforation to remove a strip of the epithelial layer. The graft is then placed in the inner surface of the tympanic membrane and the surgeon uses an antibiotic-soaked gelfoam to pack the inner ear for stability. The surgeon has to make sure that the graft completely covers the hole and that some parts of it extend over the walls of the posterior canal. After the flap is replaced, the incision is closed.
In the overlay technique, the surgeon makes an incision to raise the medial meatal skin and the harvested graft is placed on the outer surface of the eardrum. The graft is made stable may tucking it under the handle of malleus with the use of a slit. A gelfoam soaked in antibiotics is then used to pack the ear and sutures are used to close the incision.
Patients are typically allowed to go home after surgery and should rest for a few days before resuming normal daily activities. Swimming and other strenuous physical activities should be avoided until the perforation has completely healed.
Possible Risks and Complications
Risks and complications of myringoplasty are very rare, but a small percentage of patients can experience the following:
- Hearing loss
Some patients report altered taste perception as a result of injuring the chorda tympani. This condition is characterised by a persistent metallic taste while eating and could also resolve itself over time.
There is also the possibility of graft failure and recurring perforation. If this happens, the patient may need to undergo repeat myringoplasty for resolution.
Hardman J, Muzaffar J, Nankivell P, Coulson C. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis. Otol Neurotol. 2015 Jun. 36 (5):796-804. [Medline].
Chang CYJ. Chronic Disorders of the Middle Ear and Mastoid (Tympanic Membrane Perforations and Cholesteatoma. Mitchell