Myringoplasty and Perforated Ear Drum

A perforated ear drum means that there is a hole in the ear drum. This may have been caused by one of a number of different things, most commonly an infection, repeated infections or some sort of injury (which itself can be varied; either a blunt force such as slap to the side of the head, a direct penetrating injury or a head injury). A hole may also appear following certain types of ear surgery.

In many cases a perforated ear drum will heal by itself. This is usually the case after trauma to the ear or after an ear infection. Healing usually occurs quite quickly, within a few weeks at most. If, after about 6 weeks the perforated ear drum is still present, it is unlikely to repair itself.

What symptoms will I get from a perforated ear drum?

Even if the perforation persists, it is not necessarily the case that you will get symptoms from it. The biggest problem that can occur is an ear infection, usually caused by water getting into the ear. Therefore, if you can keep your ear as dry as possible, you may never get an ear infection even with a perforation. Some patients are not so fortunate and continue to experience recurrent infections. Another problem that can occur is a hearing loss, particularly if the hole is large.

How do I know if I have a perforated ear drum?

Your GP or ENT surgeon will be able to tell you by looking into the ear with an otoscope. You may also have an idea yourself if there has been a history of ear infections or trauma to the ear.

What is the treatment for a perforated ear drum?

There are two options. One is to the leave the perforated ear drum alone and for you to continue to keep your ear as dry as possible and to avoid direct water contact. If you are able to do this and subsequently do not suffer any or very few ear infections, this may be the best way forward. However, if you suffer with recurrent ear infections or if you are a keen swimmer, then you may need to consider having your perforated ear drum repaired surgically.

Why might I need to have my perforated ear drum repaired?

The benefits of closing a perforation include prevention of water entering the middle ear, thereby reducing the risk of further ear infections. It may also result in improved hearing, although this is by no means guaranteed and should not be the main reason for considering the operation.

If the hole in the ear drum has only just occurred, no treatment will be necessary until such time that it is proved that the perforation is not healing. You should discuss with your surgeon whether to wait and see, or have surgery now. This decision will be based on your own wishes and the presence of any ear infections or hearing loss caused by the perforation.

Surgery to repair the perforation – ‘Myringoplasty’

The operation to repair a perforated ear drum is called a myringoplasty. It is almost always performed with you asleep under a general anaesthetic. A cut is made either behind, in front of, or just above the opening of the ear. This incision is used to gain access to the ear drum and also to harvest the material that is then used to patch the perforation. The material that is most commonly used is muscle lining, which is tough, durable and acts as an excellent scaffold material to allow the ear drum to heal over it. Once the graft is in place, dressings are placed in the ear canal to support the graft. An external dressing and/or head bandage may also be required for a few hours after the surgery.

What should I expect after a myringoplasty?

After the myringoplasty, you will be taken to the recovery area where routine observations will be taken. You will be reviewed by your surgical team who will undertake some basic tests and check that you are recovering well. You may feel a little dizzy and disorientated which is not unusual after ear surgery, and you may have a fullness feeling in your ear and/or a ringing noise (tinnitus). When you start to feel a little better, you can eat and drink and begin to mobilise.

It may be possible to send you home on the same day as the surgery although occasionally an overnight stay is required. If you have a head bandage on, this will be removed prior to discharge.

What can go wrong after a myringoplasty?

The operation is successful at closing small to medium sized holes in approximately 85% to 90% of cases. The success rate is however not quite so good in large perforations or in patients having revision surgery.

There are some risks that will be discussed with you before your surgery. Bleeding and infection can occur after any operation but are thankfully not common after myringoplasty. You may feel dizzy or have tinnitus, which should settle quite quickly. Other risks are even less likely and include:

  • Taste disturbance: The taste nerve runs close to the ear drum and may occasionally be bruised or damaged. This can cause an abnormal taste on one side of the tongue, which is usually temporary but can on rare occasions be permanent
  • Hearing loss: In about half of patients, the hearing does not change after a myringoplasty. In almost half, the hearing improves (although in most of these the hearing does not improve by much and rarely reaches the level that the patient had before the perforation occurred). In a very small number of patients (less than 1%), severe deafness can happen if the inner ear is damaged Facial Paralysis: The nerve for the muscle of the face runs through the ear. Therefore, there is in theory a slight chance of a facial nerve weakness and paralysis. If this occurred, it would cause weakness on one side of the face, making it difficult or impossible to close one eye, make a straight smile and raise the forehead. Again it is usually a temporary phenomenon, particularly after myringoplasty. A permanent weakness is exceedingly unlikely
  • Allergy / reaction to ear dressings: The ear may develop an allergic reaction to one of the dressings often used in the ear canal. The common culprit is a chemical compound known as BIPP. If this happens, the outer part of the ear (called the pinna) may become red, swollen and tender. You should consult your surgeon so that the dressing can be removed from your ear and an alternative placed or the ear may be left open. The allergic reaction will settle within a few days

Do’s and Dont’s after a myringoplasty

Owing to the potential for dizziness and risk of postoperative infection, it is advisable to refrain from commuting to work for at least a week, if possible two weeks, after the surgery. This is particularly the case if you have a manual or dusty job, in which case the ear must be covered even when you return to work. It is important not to blow the nose and if you are going to sneeze, try to do so through your mouth to take the pressure off the ears, as otherwise the newly placed graft may become displaced. Do not engage in any exertional activities during the recovery phase, including no heavy lifting or contact sports. It is also important not to fly for 6 weeks following a myringoplasty.

One of the most important aspects of postoperative care is to keep your ear as dry as possible, in other words to avoid direct water contact which includes shower or bath water, in order to reduce the chance of an ear infection.

Follow up after a myringoplasty

You will usually be seen by your specialist after 2 or 3 weeks in order to remove the dressing in the ear. You may be prescribed some ear drops to encourage any dried blood or secretions to dissipate, and you will be strongly advised to continue to keep your ear dry for a few more weeks.