Ear, Nose and Throat Specialist Op. Dr. Melih Arif Közen, practising in İzmir, performs tympanoplasty surgery to repair a perforated or damaged eardrum. The eardrum (tympanic membrane) is a thin membrane located between the external ear canal and the middle ear; it plays a critical role in transmitting sound and protecting the middle ear from the external environment.
A persistent perforation of the eardrum may develop as a result of recurrent middle ear infections, trauma, sudden pressure changes or long-standing infections. When the perforation does not close, hearing loss, persistent ear discharge and recurrent infections may occur. Tympanoplasty aims both to improve hearing by repairing this perforation and to prevent infections by protecting the middle ear.
Small perforations of the eardrum can sometimes heal on their own. However, perforations that have remained open for a long time, that affect hearing or that cause recurrent discharge require surgical repair for a permanent solution.
What Is Tympanoplasty?
Tympanoplasty is a surgical procedure in which the perforated eardrum is repaired and, where necessary, the sound-conducting structure of the middle ear is also reconstructed. The repair generally uses a graft taken from the patient’s own tissue (cartilage membrane or muscle fascia); this tissue is placed over the perforation to achieve permanent closure. The goal is both to improve hearing and to protect the middle ear from external factors.
Repairing the Membrane
The perforation in the eardrum is closed with a graft taken from the patient’s own tissue, restoring the integrity of the membrane.
Improving Hearing
Once the membrane is repaired, sound conduction is restored; in most patients, the hearing loss caused by the perforation is significantly reduced.
Protection Against Infection
The closed membrane prevents water and germs from reaching the middle ear, helping to prevent recurrent discharge and infections.
When Is Tympanoplasty Performed?
Tympanoplasty becomes an option when the perforation in the eardrum does not close on its own and affects hearing and ear health. The most commonly evaluated causes are as follows.
Persistent Membrane Perforation
Eardrum perforations that develop as a result of recurrent infection, trauma or pressure changes and that have not closed for a long time.
Hearing Loss
Impaired sound conduction caused by the perforation in the membrane, accompanied by reduced hearing that affects daily life.
Recurrent Discharge
Frequently recurring ear discharge and infections due to water and germs passing through the open perforation into the middle ear.
Recurrent middle ear infections, particularly in children, may also indicate the need for an ear tube (ventilation tube). The right treatment is determined after a detailed ear examination.
How Is Tympanoplasty Performed?
The technique used in tympanoplasty is determined by the size and location of the perforation and by the condition of the sound-conducting structure in the middle ear. The procedure is generally performed through an incision behind the ear or through the ear canal.
Repair With a Graft
A graft taken from the patient’s own tissue (cartilage membrane or muscle fascia) is placed over the perforation to achieve permanent closure of the membrane.
Transcanal Approach
For suitable, small perforations the procedure is performed directly through the ear canal under microscopic or endoscopic guidance, leaving no external scar.
Ossicular Reconstruction
If there is damage to the sound-conducting ossicles in the middle ear, they are repaired in the same session, aiming for a better improvement in hearing.
Preparation Before Tympanoplasty
A successful tympanoplasty begins with an accurate diagnosis and a detailed preoperative evaluation. At this stage, the condition of the perforation and the degree to which hearing is affected are determined, after which the appropriate technique is planned.
Examination and Hearing Test
The location and size of the perforation are determined through microscopic ear examination. The degree of loss in sound conduction is measured with a hearing test (audiometry).
General Health Assessment
The necessary blood tests are carried out before anaesthesia. If there is active ear discharge, an attempt is made to achieve a dry ear environment with treatment before surgery.
How Is Tympanoplasty Surgery Carried Out?
Tympanoplasty is generally performed under general anaesthesia, either through the ear canal or behind the ear depending on the condition of the perforation, and takes approximately 1–2 hours. The procedure progresses through specific stages, and most patients are discharged after a short period of observation.
Anaesthesia and Graft Preparation
The patient is put to sleep and the area is sterilised. The graft to be used for the repair is harvested from the patient’s own tissue and prepared.
Repair of the Perforation
The perforation in the eardrum is cleaned, and the prepared graft is carefully placed over the perforation under microscopic or endoscopic guidance.
Fixation and Completion
Supporting material is placed in the ear canal so that the graft attaches securely. The procedure is completed and the patient is discharged after a short period of observation.
Let Us Determine the Right Solution for Your Hearing Health
You can consult Op. Dr. Melih Arif Közen regarding an eardrum perforation, hearing loss or recurrent discharge.
Recovery Process After Tympanoplasty
Recovery after tympanoplasty is a gradual process that depends on the graft attaching and the eardrum closing completely. In the early period, a feeling of fullness in the ear, mild ringing or temporary reduced hearing may occur; these are normal. The improvement in hearing becomes more apparent as the membrane heals fully.
The First Weeks
The supporting material in the ear is removed after a certain period. During this period, keeping the ear dry, avoiding water entering the ear and keeping the mouth open when sneezing are important for the graft to attach.
The Following Period
Most patients return to their daily lives within a short time. Full healing of the membrane and the settling of the improvement in hearing may take from a few weeks to a few months.
Consult your doctor without delay in the following situations:
- Increasing, persistent pain in the ear
- High fever
- Heavy or foul-smelling discharge from the ear
- Sudden and significant hearing loss, severe dizziness
Frequently Asked Questions
Will my hearing fully recover with tympanoplasty?
The main purpose of the surgery is to close the perforation in the eardrum and to improve hearing. In most patients, hearing improves significantly. The degree of improvement may vary depending on the size of the perforation, the condition of the ossicles in the middle ear and the tissue healing process.
Can water get into my ear after surgery?
Keeping the ear dry during the early healing period is very important. To ensure the graft attaches securely, water must not be allowed to enter the ear during bathing and swimming in this period. Your doctor will tell you, based on the examination findings, when you can return to normal.
Where is the tissue used for the repair taken from?
The graft is taken from the patient’s own body (usually the cartilage membrane or muscle fascia around the ear). Because it is the patient’s own tissue, there is no compatibility problem, and a permanent, natural repair is achieved.
Can the perforation open again?
In a successful tympanoplasty, the repaired membrane generally closes permanently. However, a new infection, trauma or factors affecting healing may rarely lead to re-perforation. Regular check-ups are important in this respect.