Tympanoplasty – Eardrum Repair Surgery in Kasaragod

 A hole or perforation in the eardrum can lead to repeated ear discharge, reduced hearing, discomfort while bathing, and recurrent infections. Tympanoplasty is a microsurgical procedure performed to repair the damaged eardrum and, when required, reconstruct the tiny hearing bones of the middle ear.

At our ENT centre in Kasaragod, patients with chronic ear disease and eardrum perforations are evaluated with detailed ear examination and hearing assessment to determine whether tympanoplasty can help restore a dry, safe and functional ear.

 Tympanoplasty is an operation performed to repair a perforated tympanic membrane (eardrum).

During surgery, a small piece of the patient's own tissue—commonly cartilage, perichondrium or fascia—is used to close the perforation and allow the eardrum to heal.

If the small hearing bones inside the middle ear are damaged, reconstruction of the ossicular chain may also be performed during the same procedure.

 A perforation may occur following:

• Repeated or chronic middle-ear infections
• Long-standing ear discharge
• Sudden trauma to the ear
• Slap or blast injury
• Injury from inserting objects into the ear
• Previous ear surgery
• Pressure-related ear injury
• Severe acute ear infection

Some perforations heal naturally. However, a perforation that persists for several months may require surgical repair.

 Patients may experience:

• Reduced hearing
• Repeated ear discharge
• Ear infections after water enters the ear
• Blocked or hollow sensation in the ear
• Tinnitus or ringing sensation
• Difficulty hearing conversations
• Occasionally ear discomfort

A chronically discharging ear should be evaluated by an ENT specialist because conditions such as cholesteatoma may require a different type of ear surgery.

Tympanoplasty may be considered when there is:

A perforation that has failed to heal naturally.

Repeated infections despite appropriate medical treatment.

Hearing reduction caused by the perforation or damage to the middle-ear hearing mechanism.

Patients may repeatedly develop ear infections following bathing or swimming.

Repairing the eardrum creates a barrier between the ear canal and the middle ear.

Before surgery, your ENT surgeon may perform:

Otoscopic or Microscopic Ear Examination

The size and location of the eardrum perforation and condition of the middle ear are assessed carefully.

Endoscopic Ear Examination

Endoscopes provide a magnified view of difficult-to-see areas of the eardrum and middle ear.

Hearing Test – Pure Tone Audiometry

Audiometry helps determine the amount and type of hearing loss.

Tympanometry

This may be performed in selected patients to assess middle-ear function.

CT Scan

A CT scan is not necessary for every simple perforation. It may be advised when there is suspicion of cholesteatoma, extensive chronic ear disease or other middle-ear or mastoid pathology.

 Modern ear surgery can often be performed using a high-definition endoscope.

The endoscope allows the surgeon to obtain a wide-angle view of the eardrum and middle ear through the natural ear canal.

In selected patients, this may allow tympanoplasty to be performed without a large incision behind the ear.

• Excellent magnified visualization
• Better view of hidden recesses of the middle ear
• Surgery through the natural ear canal in suitable cases
• Smaller external incision or no post-aural incision in selected patients
• Good cosmetic outcome

The choice between endoscopic and microscopic tympanoplasty depends on the perforation, anatomy of the ear canal and extent of middle-ear disease.

The objective is not simply to use a particular technology, but to select the surgical approach that provides the safest and most effective repair.

 Microscopic ear surgery remains an important and highly effective technique.

An operating microscope provides binocular magnification and excellent depth perception. It may be particularly useful in complex middle-ear reconstruction, ossicular surgery and situations requiring wider surgical access.

In many cases, microscopic and endoscopic techniques may complement each other.

 The operation is usually performed under anaesthesia.

During surgery:

1. The edges of the perforation are prepared.
2. The middle ear is inspected.
3. Any unhealthy tissue is removed when necessary.
4. The hearing bones are assessed.
5. A graft is placed to reconstruct the eardrum.
6. The graft is supported while healing occurs.

Depending on the condition of the ear, cartilage, fascia or other suitable graft material may be used.

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One of the important goals of tympanoplasty is to create a safe and dry ear.

Hearing may also improve when the eardrum heals successfully, particularly when the hearing bones are intact.

However, the amount of improvement depends on factors such as:

• Size and location of the perforation
• Condition of the middle-ear mucosa
• Function of the Eustachian tube
• Condition of the hearing bones
• Previous ear infections or surgery
• Inner-ear hearing function

Your expected hearing outcome can be discussed after examining the ear and reviewing the hearing test.

 Sometimes chronic ear disease damages the tiny hearing bones called the:

• Malleus
• Incus
• Stapes

If necessary, these bones can be repaired or reconstructed during surgery.

This procedure is called ossiculoplasty.

Cartilage, the patient's own ossicles or specially designed middle-ear prostheses may be used depending on the condition found during surgery.

 Not every patient with ear discharge requires the same operation.

A simple dry eardrum perforation may require only tympanoplasty.

However, patients with:

• Cholesteatoma
• Extensive chronic ear infection
• Retraction pockets
• Disease extending into the mastoid
• Complications of chronic otitis media

may require mastoidectomy with tympanoplasty.

A detailed ENT examination helps determine the appropriate procedure.

 Most patients can return to routine light activities relatively soon after surgery, but the reconstructed eardrum requires several weeks to heal completely.

During recovery you may be advised to:

• Keep the operated ear completely dry
• Avoid forceful nose blowing
• Avoid inserting anything into the ear
• Use prescribed ear drops or medicines correctly
• Attend scheduled follow-up visits
• Avoid swimming until your surgeon confirms that healing is complete
• Avoid strenuous activity for the advised period

Temporary ear blockage or reduced hearing can occur while the ear canal packing is present.

Hearing assessment is usually performed after adequate healing.

 Patients with an eardrum perforation should avoid water entering the ear.

While bathing, a small piece of cotton coated externally with petroleum jelly may be placed gently at the entrance of the ear canal.

Do not push cotton, earbuds or other materials deeply inside the ear.

Swimming should generally be avoided unless your ENT specialist specifically advises otherwise.

 Consult an ENT specialist promptly if ear discharge is associated with:

• Severe giddiness
• Sudden worsening of hearing
• Facial weakness
• Severe headache
• Fever and vomiting
• Pain or swelling behind the ear
• Persistent foul-smelling or blood-stained discharge

These symptoms may indicate complications of chronic ear disease and require early evaluation.