Should a perforated eardrum be operated?

Tympanoplasty is an operation to repair problems affecting the tympanic membrane (perforations), the ossicles chain (hearing loss) or both.

Tympanoplasty technique

To repair the tympanic membrane, the otolaryngologist uses the patient’s own tissue; it is placed as a patch to close perforations or to reinforce weakened areas. On the other hand, the affected ossicles chain is repaired with other ossicles, with cartilage, or with prosthesis made of materials that have proven to be well tolerated.

Tympanoplasty surgery can be performed inside the canal, without visible external incisions, or through an incision behind the ear. Sometimes, even when performed inside the canal, small incisions can be made around the canal.

Normally, the incision is made under local anesthesia and sedation, but in some cases it is preferable to resort to general anesthesia.

On the other hand, sometimes the repair of the ossicles is performed in another operation a few months later, once we have achieved a healthy ear.

Consequences of Tympanoplasty

The repair of the tympanic membrane has a success rate of between 80 and 90%. The recovery of the hearing loss is very variable, it depends on the level of hearing before the operation and the state of the ossicles chain.

On the other hand, the scars of the operation are not very visible and are not usually unsightly. As for ear noises, they usually remain unchanged, although they may worsen or improve.

Risks of Tympanoplasty

The following situations may occur during tympanoplasty:

  • New perforation of the eardrum (10% chance).
  • Complete hearing loss in the treated ear in 0.5-1% of cases.
  • Facial paralysis (one in 500 cases).
  • 1 in 20 patients may have short-term facial paralysis as a consequence of local anesthesia.
  • Vertigo
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Alternatives to Tympanoplasty

The only alternatives to tympanoplasty are abstention from the operation together with close surveillance. In the case of a dry perforation that does not ooze, an expectant attitude can be adopted, although the perforated ear has a higher risk of infections and hearing loss than the one that is not perforated; therefore, the operation is advisable.

In case of chronic suppuration, the risk of hearing loss and other rare complications (mastoiditis, facial paralysis, meningitis, thrombophlebitis, etc.) makes intervention necessary. On the other hand, in case of hearing loss, with an intact eardrum, the alternative is the fitting of a hearing aid.