Tympanoplasty

Why does my child need a tympanoplasty?

The eardrum is a thin membrane deep in our ear canal.  This membrane vibrates when sound enters the ear helping to deliver sound to the brain allowing us to hear. The medical word for eardrum is tympanic membrane. A tympanoplasty is a surgical procedure to close a hole in the eardrum. 

Ear drum holes (perforations) can come from a bad ear infection, an ear tube, or from trauma such as a Q-tip® poked deep inside the ear canal. Tympanoplasty surgery is a common way to repair a perforation that has not healed itself.

Do eardrum perforations cause hearing loss?

Many parents are concerned that a hole in the eardrum will cause permanent hearing loss. This is not usually true. In fact, some perforations don’t cause any hearing loss.  The effect a perforation has on hearing depends on the size and location of the hole. Luckily, most perforations are small and located in areas that don’t affect the hearing much if at all.

Although eardrum holes do not cause total deafness, large ones and even some smaller ones can cause mild or moderate hearing loss.  Hearing loss usually returns to normal, or very close to normal, after the hole is closed.

Should all eardrum perforations be fixed?      

Some perforations do not require any special treatment.  When an eardrum ruptures during a bad ear infection, the infection usually drains out through the hole.  After a few days, the hole will often close all by itself.  Sometimes the infection lingers for a while and may need additional treatment with an oral medication and/or ear drops. After the infection is finally clear, the hole usually closes by itself.

If a perforation has been present for many months without infection or drainage it is less likely to close by itself.  At this point, your doctor may recommend that you consider having the hole closed surgically.  The decision to surgically close a perforation is sometimes a difficult one to make. It depends on a variety of factors including your child’s age, recent history of infections, problems with the other ear, and the amount of hearing loss (if any). A pediatric ear, nose and throat surgeon can help you decide if it’s the right time to repair your child’s eardrum perforation.

How is an eardrum perforation repaired?

There are three ways to repair an eardrum perforation. Your ENT provider will discuss which method is best for your child. Eardrum repairs are performed by an ear, nose, and throat surgeon in the operating room under general anesthesia. In this day and age, general anesthesia is very safe and your child will be carefully monitored by the anesthesia team during the procedure.

The simplest kind of eardrum repair is called a patch myringoplasty [mer-RING-go-plass-tee].  In this procedure, the hole is covered with material to temporarily plug the hole. This encourages the body’s normal healing process to close the hole. The material is usualy a small piece of paper or gelatin. A patch myringoplasty usually takes between 5 and 10 minutes. However, it is only useful for relatively small holes in the center of the eardrum.

A more involved type of patching procedure is a fat or cartilage myringoplasty. For this procedure, your surgeon will take a piece of your child’s tissue and use it to plug the hole. The tissue is usually fat from the ear lobe or a piece of cartilage from the ear canal. Compared to the patching procedure, this type of tissue graft has a better chance of closing larger and older perforations.

The most common and lengthy procedure for repairing a large hole in the eardrum is called a tympanoplasty [tim-PAN-o-plass-tee]. In this procedure a tissue graft is placed underneath the hole. This graft may be cartilage taken from the outer part of the ear, connective tissue taken from underneath the skin behind the ear, or even a commercial biologic material that comes in a box.

To insert the graft the eardrum is lifted up like a trap door and the graft is slipped underneath the eardrum. Then the eardrum is put back where it started and self-dissolving packing material is used to hold everything in place during healing. After the packing dissolves in 8 to 12 weeks the hearing is usually restored to normal.

Sometimes a tympanoplasty can be performed through the ear canal and sometimes it requires an incision behind the ear. Although a behind-the-ear incision involves more healing and recovery, it improves the success of the operation in difficult cases. And best of all, when completely healed, the incision is completely hidden by the outer ear!

Are there any instructions I need to follow before surgery?

Your child must have a physical examination by their pediatrician or family doctor within 30 days before surgery to make sure they are in good health. The provider you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day or surgery. If your child does not have a preoperative history and physical, the surgery will be cancelled.

For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child’s surgery will be cancelled.

What can I expect after surgery?

A patch myringoplasty usually takes 5 to 10 minutes. A fat or cartilage myringoplasty takes less than 1 hour. A tympanoplasty can take 1 to 3 hours.

Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour. When your child is awake, he or she will be taken to the post-operative area to complete the recovery. You can be with your child once he or she has been transferred to this area.

Children can almost always go home the same day of surgery. In rare cases, an overnight stay may be necessary (e.g., you child has excessive nausea or vomiting). If your child does stay overnight, one parent or caregiver is required to stay overnight too.

Your child may have bloody drainage or drainage from the ear canal for a few days after surgery. This is normal and is no cause for alarm.

Ear pain and soreness are also common after surgery. These symptoms should go away during the first 3 to 5 days after surgery. Your surgeon may prescribe pain medicine to take home for the first few days after surgery.

How should I take care of my child after surgery?

You should keep the ear canal clean and dry until you see your surgeon after surgery (usually 3 to 4 weeks after surgery). During the recovery, you can keep a clean cotton ball in the ear canal and change it as often as needed. You will probably need to change it quite often during the first few days if the ear has bleeding or other drainage.

During baths or showers, coat a cotton ball with ointment (Bacitracin, Vaseline®, or Aquaphor®) and place it in the opening to the ear canal. The ointment will prevent water from seeping into the ear canal. After bathing, replace the cotton with a fresh, dry cotton ball. Do this until you see your surgeon in clinic.

If your child had a behind-the-ear incision, the ear will be bandaged with a gauze dressing and a soft surgical headband. You may remove the headband and gauze the day after surgery. You can replace the headband if you child likes having the ear covered. It does not have to be tight. Keep the incision dry for 3 days after surgery. You can then get the back of the ear wet. Pat the area dry after showers or baths—do not rub the incision area. If there are little tapes on the skin (Steri-Strips™) let them fall off on their own. They may even stay in place until you see your surgeon for follow up after surgery.

In most cases, your child may return to school or daycare within 1 or 2 days after surgery. There is no need to restrict regular, non-strenuous activity after your child feels back to normal. Vigorous exercise (such as swimming, running, jumping, and lifting heavy objects) should be avoided until your next ENT clinic appointment.

If your child complains of pain in the ear, you can safely give Tylenol^® (acetaminophen), Children's Motrin^® (ibuprofen), or other pain medicine prescribed by your surgeon. If you are not sure what medicines are safe, please call your doctor. 

Fevers up to 102.0 F are considered normal after surgery. Call your provider for fevers over 102.0 F that do not come down with acetaminophen and/or Ibuprofen 

What else do I need to know?

Prolonged dizziness or persistent vomiting are uncommon after eardrum surgery. Please call our office if your child continues to vomit more than 24 hours after surgery or is having difficulty standing or walking.

Your child should not go swimming or fly in an airplane until your doctor specifically tells you that it is okay to do so.

If your child has a tympanoplasty, hearing will be affected in the operated ear until all of the packing behind the eardrum completely dissolves. This can take up to 2 to 3 months. In fact, the hearing will probably be worse than it was before surgery, especially the first few weeks after surgery.

At your next clinic visit, your surgeon may gently clean the ear canal and inspect the reconstructed eardrum. You may be asked to use some antibiotic ear drops for a week or two to help with healing.

A hearing test will be done when the eardrum has finished healing (usually 8 to 12 weeks after surgery).

If you have any questions or would like further information specific to your child, please call our office at 612 874-1292.

Questions?

The information provided in this brochure is not specific to your child. This information is provided as s service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child’s medical provider.

Reviewed 10/2022

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