What is a Myringoplasty?
A hole in the eardrum may be caused by infection or injury. In the first six weeks after it occurs, a hole in the eardrum may heal itself. Some people have holes in their eardrums and do not get any problems. However, many people find that the ear will discharge when they get the ear wet or if they have a cough or a cold. Additionally, there may be some hearing loss.
An operation to repair the perforation is called a ‘Myringoplasty’. The main aim of the operation is to decrease the amount of discharge from the ear. It may also result in improved hearing, but repairing the eardrum alone seldom leads to a great improvement in hearing.
What does the operation involve?
The day of the operation:
Admission is almost always on the day of surgery. The nurses will complete some routine paperwork and tests. You will be asked to change into a gown ready for theatre. The anaesthetist will come to see you and discuss the anaesthetic side of things. A member of the ENT team will also see you before your operation.
In children, the operation is performed under general anaesthetic. In adults, it may be possible to perform the operation under local anaesthetic.
The operation itself:
There are a number of ways of performing this operation. It may be necessary to make a cut behind the ear or just in front of the ear. In all cases, the operating microscope is needed and micro-instruments are used to lift the eardrum up. A tiny piece of tissue is taken and placed under the eardrum to encourage the hole to heal. This piece of tissue is normally taken from the cut that is made at the beginning of the operation.
You will wake up with a bandage around the head. This is to put some pressure on the wound to stop any bleeding. This will be removed before you go home.
In most cases, an antibiotic dressing will be placed in the ear canal. You may need to put some antibiotic ear drops into the ear to try to prevent an infection. If you do have drops to use, you should remove any cotton wool from the outer ear in order to instil the drops into the ear canal. A fresh piece of cotton wool can be placed in the outer ear if the ear is wet and leaking. The dressing will normally be removed in the clinic 2-3 weeks after surgery. Alternatively, an antibiotic ointment may be used which will slowly dissolve. Your surgeon will discuss this with you after the operation. There may also be some sticky plasters (steristrips) on the wound behind or in front of the ear. The stitches in the wound are usually buried under the skin and will dissolve.
After the operation:
After a short time in the recovery area, you will be taken back to the ward. You will be encouraged to drink and then eat as soon as the anaesthetic has worn off. The procedure is not normally painful but you will be given painkillers as required.
Your discharge from hospital:
Most patients are able to go home on the day of the surgery but some patients may have to stay overnight. You will need to arrange for a responsible adult to pick you up to take you home and stay with you for 24 hours after discharge (following a general anaesthetic). Depending on how fit and active you are before your operation, you may need to arrange for someone to stay with you for a few days.
POST OPERATIVE CARE
What should I do when I leave the hospital?
Be sure to keep the ear dry and do not go swimming. The best way to achieve this is with cotton wool and Vaseline to the outer ear canal. The wound behind the ear can get wet. Pat, it dry with a towel but do not rub it as you might open up the wound.
You should not fly until your surgeon is happy that the ear has healed. This is because changes in the ear pressure especially during take-off and landing can push the graft out of place. Healing can be confirmed by your surgeon in outpatients. This is usually at around 6 weeks after the surgery.
You should not drive for at least 24 hours following your operation. You can then drive when you are able to perform an emergency stop safely.
There may be some blood-stained discharge from the ear canal for several days. This is to be expected and can be dealt with by placing some cotton wool in the outer ear. Do not use any earbuds in the ears as you will cause damage.
Some patients will have Steri Strips (thin, sticky plasters) on the wound. These can be removed by yourself after a week. Stitches are usually buried under the skin and will dissolve but if you have stitches that are visible on the surface, they need to be removed a week after the operation, usually at the GP’s surgery. You will be informed by your surgeon which stitches you have. If there is a small dressing in the ear canal, this will be removed in the outpatient department by your surgeon. This is normally a straightforward procedure but in some very young children, it may be performed under a short day-case anaesthetic. If a large piece of dressing was to fall out of the ear soon after the surgery please contact your surgeon for advice as a new dressing may be necessary.
Follow up arrangements will be made to ensure that the eardrum has healed.
You may feel rather tired for a week or so, but this will steadily improve. You should be fine to return to work/school one week after surgery. If your work requires heavy manual labour, then your surgeon may recommend that you have more time off to allow the ear to heal.
Are there any risks involved in this operation?
Although modern surgery and anaesthetics are considered to be safe, all medical procedures carry some risks. The surgeon will discuss all these risks with you.
All surgical procedures involving the middle ear may cause the following rare complications:
Your surgeon will discuss these risks with you further in the clinic.
Risks associated with a general anaesthetic are rare and include:
How good are the results?
The success rate for Myringoplasty (success meaning an intact eardrum) varies from 60% to 90%, depending on the size and position of the perforation, past history of discharge, age of the patient and whether or not the operation has been tried before. Mr Price has audited his results and the success rate is 89%. It is usually possible to tell whether it has worked at your visit 6-8 weeks after the operation. Hearing improvement will depend on the amount of hearing loss before the operation, and whether the small middle ear bones are healthy.
Are there any alternatives to this operation?
Before surgery is recommended simple cleaning in the clinic and antibiotic drops or tablets may have been used already. If you are happy with your hearing level overall, the ear does not discharge often and you are not a keen swimmer and can keep the ear dry, you may not want any surgery. Your G. P. will be able to treat any infections with antibiotic drops or tablets. The hearing is unlikely to get any better or any worse, and the size of the perforation is not likely to change so surgery is not essential.
If you would like a second opinion about the proposed surgery please ask your G.P or Surgeon to arrange this.
Are there any risks of not having this operation?
If you decide not to have surgery your symptoms may persist or worsen.
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