Tympanoplasty Patient Information

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

What are the indications for a tympanoplasty (repair of the eardrum)?

The indications for a tympanoplasty include a chronic tympanic membrane perforation (a hole in the eardrum) or a cholesteatoma. Chronic tympanic membrane perforation can be a result of multiple causes including chronic suppurative otitis media (ear infection), iatrogenic causes (from ear tube placement), and trauma. Most iatrogenic and traumatic tympanic membrane perforation will heal spontaneously with conservative observation. However, there is a small subset of patients that will continue to have a persistent perforation despite prolonged observation, thus requiring surgical treatment. In addition, a tympanoplasty is also indicated for chronic retraction of the eardrum (retraction pocket) in order to reduce the risk of a cholesteatoma formation and additional hearing loss.

What is a tympanoplasty and how is it performed?

A tympanoplasty (or its variation, a myringoplasty) is an outpatient microscopic surgical procedure designed to repair the tympanic membrane (the eardrum). While there are many different approaches, the goal is to provide a scaffold (patch) to allow the eardrum to heal.

The surgery is usually performed under general anesthesia and utilizes a microscope (microsurgery) for a magnified view. Usually, an incision is made behind the ear and a graft (patch) is obtained from the tissue in the scalp. Depending on the size of the ear canal, the size of the perforation, and the location of the perforation, the approach may be from behind the ear or entirely through the ear canal. The graft is then used to patch the hole and to allow the eardrum to heal. The scar from a tympanoplasty is typically minimal and well hidden behind the ear.

What should I expect before surgery?

• To prepare for your surgery, your physician may prescribe preoperative medications to optimize the condition of your sinuses for surgery. The medications may include topical or oral antibiotics. Be sure to start any preoperative medications on the appropriate day and adhere to the direction.
• DO NOT TAKE THE FOLLOWING MEDICATIONS FOR AT LEAST 14 DAYS PRIOR TO SURGERY: aspirin, ibuprofen (Motrin/Advil), naproxen (Aleve), other non-steroidal anti-inflammatories (NSAIDS), vitamin E (multivitamin is OK), gingko biloba, garlic (tablets), and ginseng. These medications can thin the blood and create excessive bleeding. Tylenol is safe and may be taken any time up to the day of surgery. St. John's wort should also be avoided for 2 weeks prior to surgery because of possible interactions with anesthesia medications. If you take the blood thinner Coumadin or Plavix, you must discuss this with your surgeon so the medication can be discontinued before surgery and restarted appropriately.
• If you smoke, you must stop smoking for at least three weeks prior a tympanoplasty, and at least four weeks after surgery. Smoking can contribute to scarring, poor healing, and failure of the operation. Your primary care physician can direct you to resources for smoking cessation.
• While our office will make every attempt to keep your primary care physician informed before and after your surgery, it is important that you personally inform him/her that you are planning to have ear surgery. If you have underlying medical conditions, your primary care physician may help to clear you medically for surgery. Most of the necessary pre-operative testing will be performed at Bellevue ENT during your preoperative visit. This takes place approximately 1 week prior to your surgery if needed.
• Due to the frequently changing operating room schedule, the surgery center will usually call you one business day before your surgery date to inform you of your surgery time. You are usually expected to arrive two hours prior to your surgery to check in.

What should I expect during surgery?

Your surgical team will include your surgeon, an anesthesiologist, a scrub nurse, a circulating nurse, and additional supporting staffs dedicated to ensuring that your surgery is safe. A tympanoplasty is typically performed under general anesthesia and take about 1-2 hours. However, this may vary depending on each patient.

Typically, ear packing is placed both in the middle ear and in the ear canal. The packing is usually dissolvable. Dissolvable sutures are usually placed behind the ear and tape may be placed over the wound. A cup-like device (Glasscock dressing) will be placed over your ear, which remains in place for two days.

What should I expect after surgery?

• After your surgery, you will spend approximately 1-2 hours in the recovery area. Approximately 1 hour after you arrive in the recovery area, a family member or friend should be able to visit with you. Most patients feel well enough to go home the same day. You should not drive yourself home and you need to arrange for transportation prior to surgery.
• You can expect mild drainage onto the dressing for 1-2 day after surgery. Pain can generally be controlled with over the counter Tylenol; however, narcotic (prescription) medication will be provided for additional control if needed.
• You will start antibiotic ear drops twice a day into the ear once you remove the ear dressing two days later. You may notice some bloody drainage from the ear when you start the antibiotics. This is normal and should be cleaned as needed.
• You may eat a regular diet.
• You will have return visits to the ENT clinic at approximately 1, 4 weeks and 8 weeks after surgery. At your first post-operative visit, your doctor will examine the wound to make sure that it is healing well. Please write down any questions you may have so that we can answer them at your appointment. At your second follow up, your doctor may remove any additional packing that is still in your ear. At your third visit, you will obtain a hearing test to evaluate your hearing level.
• You should plan on taking one week off from work and ideally have a half-day planned for your first day back.
• Please see the post-operative instructions for additional details.

What are the risks of a tympanoplasty?

As with any surgical procedure, a tympanoplasty has associated risks. With meticulous planning appropriate precautions, complications from a tympanoplasty are very rare. Although the chance of a complication occurring is very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have. These risks may include:

• Hearing loss: While one of the goals of a tympanoplasty is to improve your hearing, there is an inherent risk of additional hearing loss anytime surgery is performed on the ear. This is exceeding rare and typically can be corrected when occurred.
• Recurrence of disease: The majority of patients who undergo a tympanoplasty do not need any additional surgery. However, there is a small subset of patients (particularly in patients with chronic Eustachian tube dysfunction) that may develop a recurrent tympanic perforation. If this occurs, then additional repair can be performed if it is appropriate.
• Taste alteration: During a tympanoplasty, a small nerve called the chorda tympani that is usually dissected and preserved. The nerve provides taste to the anterior (frontal) aspect of the tongue on the same side that the surgery is performed. While it is rare, if the nerve is injured, patients may notice a decreased sense of taste or a metallic taste at the anterior aspect of the tongue on the side of the surgery. In the event of an injury, the taste alteration will typically subside about two months after surgery.
• Facial nerve injury: Facial nerve injury and facial weakness is a complication that has been reported after a tympanoplasty. It is more commonly seen in patients with high-risk features including a cholesteatoma or congenital craniofacial malformations. The potential for recovery in such cases is not good. Fortunately, such a complication is extremely rare. During surgery, the nerve is usually monitored to minimize the risk of injury.
• Other risks: Other uncommon risks of surgery include dizziness and ear fullness. This will usually subside with time.

What restrictions will I have during the postoperative recovery period?

• DO NOT BLOW YOUR NOSE for one month after surgery. You may sniff back. If you need to sneeze, do not suppress it but instead sneeze with your mouth open.
• Do not fly without your doctor’s clearance for one month after surgery.
• No strenuous activity for two weeks after surgery. No straining or lifting more than 10 lbs for four weeks. You should not bend over at the waist to pick things up. Instead, bend at the knees with your head up. Light walking and normal household activities are acceptable immediately after surgery. You may drive the day after surgery if you are not requiring narcotic pain medication.
• You should plan on taking one week off from work and ideally have a half-day planned for your first day back.

Your surgeon is committed to providing you with the highest level of care in a comfortable and caring environment. We want you to have all of your questions answered and provide you with a complete understanding of your ear condition and tympanoplasty. Please feel free to ask questions about any aspect of your care.

Learn more about tympanic membrane perforation (ruptured ear drum) and post-operative care after a tympanoplasty.