CNC Hearing and Balance Center Neurotologist Moises Arriaga discusses the surgical repair of the ear drum using Tympanoplasty.
The hearing mechanism includes two components: the mechanical component and the nerve component. The mechanical component includes the sound coming through the ear canal, vibrating the eardrum, going across the three hearing bones, the hammer, the anvil, and the stirrup or the malleus, incus, and stapes.
The second part of the hearing process begins at the bottom of the stirrup, or the stapes, where the vibration reaches the inner ear fluids in the inner ear called the cochlea. Theseclittle hairs vibrate and create an electrical signal that goes all the way to the brain.
There can be problems in each of these parts. There are strategies to repair problems with the ear drum. Holes can develop in the ear drum from infections, from trauma, something as simple as diving into a pool or a slap on the side accidentally, can cause a hole in the eardrum. Or sometimes, after a tube for fluid drainage has fallen out, sometimes the hole doesn’t close up completely.
We have very effective strategies to fix those holes when nature doesn’t take care of it. If a hole happens by accident or from a trauma, usually by the end of the month, most of those holes have closed up on their own. But about 5% of holes don’t close up on their own, and in that case, we can fix those holes with an operation called a Tympanoplasty.
What’s involved in a Tympanoplasty is that we make an incision behind the ear so we can sneak in more effectively and have enough room to see the ear drum. And then, we use some of the patient’s own tissue. We like to use cartilage that’s part of the framework of the ear. We typically will hide the incision just underneath that tag of tissue in front of the ear so that we can steal some of this cartilage. And then, we place that to replace the hole in the eardrum. This strategy using cartilage to replace the eardrum is over 95% effective. It’s an outpatient operation that lasts about one hour and 15 minutes. After surgery, we tell adults the same thing we tell children: one week off school, two weeks, no gym. We don’t want any heavy lifting for a couple of weeks.
We’ll pack the ear mainly with ointment and a little bit of absorbable gelatin foam packing. That packing, ointment, and the gelatin sponge will dissolve. The first week you might have some leakage coming from the ear as that ointment melts. After that though, there’s a little dry scabbing in the ear, and so a week after surgery, we use antibiotic eardrops to dissolve that packing away. We check the ear at the two week point to make sure that healing is coming along nicely, and by the three month point, the ear drum should be fully healed.
Credit: some images courtesy of National Institute on Deafness and other Communication Disorders.