A ruptured or damaged eardrum also referred to as the tympanic membrane, often heals on its own. However, in some cases, you may require a tympanoplasty surgery to treat a perforated or damaged eardrum to improve hearing. Otolaryngologists or ENT surgeons diagnose and treat damaged eardrums based on the severity of the perforation and available treatment options.
Perforation in the eardrum can be a result of bacterial infection in the inner, middle, and outer ear, injury, long exposure to loud music, or insertion of a foreign item in the ear. The tympanic membrane is a thin layer of tissue present in the middle ear that receives the vibrations of sound. Sometimes, due to changes in air pressure which can occur due to water diving, air travel, etc., the tympanic membrane or eardrum ruptures, resulting in the perforation of the eardrum.
Here we are discussing the different diagnostic tests done before tympanoplasty and different techniques used by the ENT surgeons to treat ruptured eardrums. Let us also discuss how you can prepare for the surgery and several post-surgery recovery tips that can help you recover swiftly after the procedure.
Types of Tympanoplasty: These are the following five types of tympanoplasty:
- Type I Tympanoplasty (Myringoplasty): Repair of the TM alone; no abnormality of the middle ear.
- Type II Tympanoplasty: Repair of the TM and middle ear; the malleus is eroded.
- Type III Tympanoplasty: Repair of the TM onto the stapes head; the malleus and incus have a defect.
- Type IV Tympanoplasty: the TM is grafted to the stapes footplate, which is movable.
- Type V Tympanoplasty: It is used when a footplate of stapes is fixed.
How is a Perforated Eardrum Diagnosed?
The ENT specialist examines the signs of perforation to determine the severity of the condition. This includes physical examination and several diagnostic tests to evaluate the condition of the ear. Here are some diagnostic procedures before tympanoplasty –
- Physical examination – The otolaryngologist inspects the ear canal with the help of equipment called an otoscope. This device gives a clear view of the eardrum to check the extent of perforation. In addition, the ENT doctor may also put slight pressure on the cheek around the ear to check the tenderness or facial pain in severe cases.
- Tympanometry- The doctor uses a device to measure the eardrum’s response to differences in air pressure. The measurement helps detect the perforation in the eardrum.
- Audiology exam- The otolaryngologist plays different volumes and pitches to check how well you hear sounds. The test is conducted in a soundproof setup.
- Ear discharge- A swab of an ear discharge is taken for culture to identify any signs of infection in the middle ear that can cause perforation.
- Tuning Fork- Two-pronged metal instruments are used to produce sound when struck together. The sound helps in evaluating the hearing quality of the patient.
What Happens During a Tympanoplasty?
Tympanoplasty is performed if the eardrum is significantly ruptured or in case of a chronic ear infection that is immune to medications. Before the surgery, the doctor administers anesthesia to the patient for a painless experience throughout the procedure. The ENT surgeon then uses a precision laser to remove excess tissues that may have built up in the ear.
Finally, a small patch of your own tissue is taken from the muscle sheath and grafted onto the hole in the eardrum to close it. It involves small incisions behind your ear to access your eardrum to repair it. Tympanoplasty is a daycare procedure where you can go back home on the same day of the surgery after consulting with the doctor.
Different Techniques of Tympanoplasty to Treat a Ruptured/Perforated Eardrum
There are different techniques used in tympanoplasty depending on the severity of the condition and preference of the patient or the surgeon. All the procedures are done under general anesthesia, which means the patient is unconscious throughout the procedure and does not feel any pain. Some of the surgical methods to treat perforated eardrum are –
- Patch Tympanoplasty – It is a minor procedure where the ENT surgeons place a small patch over the hole in the eardrum. The procedure usually takes a few minutes to complete with almost no post-surgery complications.
- Fat Tympanoplasty – In this procedure, the surgeon freezes the ear lobe to remove a small amount of fat tissue. The fat tissue is then placed in the eardrum through the hole. This technique can roughly take 15 minutes, depending on the surgical expertise of the surgeon.
- Medial Tympanoplasty – This procedure is slightly complex as it involves minimal incisions behind the ear to access the eardrum. The surgeon then lifts the eardrum to graft the tissue under it. The whole procedure can take around 30 minutes to one hour to complete.
- Lateral Tympanoplasty – This technique is used when the hole in the eardrum is significantly large or other surgical methods are ineffective against the perforation. The surgeon makes an incision behind the ear to remove the eardrum. A new eardrum formed from a tissue graft is then implanted back into the ear. The duration of such type of surgery usually takes up to 2 hours.
How to Prepare for the Tympanoplasty Procedure?
It is important to follow pre-surgery instructions before the tympanoplasty to avoid complications during the operation. The ENT specialist or the healthcare facility provides a set of do’s and don’ts that can help you prepare for the perforated eardrum (tympanoplasty) surgery. Here is what you should keep in mind before going for a tympanoplasty procedure –
- It is important to inform your otolaryngologist regarding current medical conditions or any ongoing medications such as OTC drugs and dietary supplements.
- Inform your doctor if you or someone in your family has a history of allergic reaction to anesthesia or bleeding disorders.
- Consult with your ENT specialist before taking any medicines before the surgery.
- Do not eat or drink anything 8-9 hours prior to the surgery. Anesthesia is more effective on an empty stomach which is why the doctor may ask you to not eat after midnight before the day of the surgery.
What Can You Expect After Your Tympanoplasty?
After the tympanoplasty procedure, you will be shifted to the observation room to see the recovery process, where your health will be monitored. You may feel dizzy as the effect of anesthesia begins to wear off. You may feel slight discomfort around the area of the incision. A dedicated nurse will monitor your vitals to check your recovery process after the surgery.
The ENT specialist will physically examine your health conditions after the anesthesia wears off. You may be discharged within 24 hours of surgery if the doctor sees significant recovery with no signs of complications. There may be swelling, redness, or discomfort around the surgical site, which will subside by prescribing medications by your doctor.
Recovery After Tympanoplasty
Tympanoplasty is an advanced procedure that ensures minimal blood loss for a faster recovery. You can expect to resume your daily lifestyle within 3-4 days after the procedure. However, complete recovery may take around 2-3 months. Therefore, it is important to keep in touch with our otolaryngologist to avoid complications and examine the recovery process.
The recovery after the tympanoplasty surgery usually depends on the medical health of the patient and how strictly they follow post-operative instructions. Here are a few tips you can follow for a quick and smooth recovery –
- Avoid blowing your nose too hard as it can put excessive pressure on the eardrum.
- It is best to avoid swimming or other water sports to keep water from entering the ear. You can also wear an earplug while showering or bathing to protect the ear and keep it dry.
- Regularly take prescribed medication to reduce discomfort or pain during the healing process.
- Wear a cap while swimming or taking a shower to keep water from entering your ear.
- Avoid intense physical exercise while the eardrum is still healing. The doctor can allow some physical activities after examining the condition of your eardrum post tympanoplasty procedure.
- You can also put a warm compress on the ear with a light hand to reduce the ear pain and minimize swelling around the ear.
Conclusion
Tympanoplasty is an advanced procedure to treat perforations in the eardrum and restore or improve hearing. There are several techniques and surgical procedures that can be done for a ruptured tympanic membrane based on the extent of perforation. Children and adults who undergo tympanoplasty experience significant relief from conditions like chronic earache, pus-like discharge from the ear, continuous ringing sound in the ear, etc.
Tympanoplasty also offers negligible chances of recurrence of perforation and has long-term health benefits. However, it is important to follow post-surgery instructions for a smooth recovery and avoid any chances of complications. Consult Pristyn Care top ENT specialists if you are experiencing symptoms of a ruptured ear to avoid complications and improve the quality of life.
