Myringoplasty

Myringoplasty is the procedure where a defect or perforation of the tympanic membrane (eardrum) is repaired. This can help to prevent future episodes of middle ear infection. In some cases, this surgery can also improve hearing in the affected ear.

Why do I need this surgery?

This surgery allows the defect or perforation in the tympanic membrane to be repaired, thereby sealing the middle ear space and reducing the incidence of recurrent infections of the middle ear space. The surgery also restores the completeness of the ear drum allowing the ear drum to vibrate and transmit sound to the rest of the middle ear structures.

What does it involve?

The surgery is performed usually under general anaesthesia and involves an incision either in front of or behind the ear to harvest some tissue to be used as graft material. This tissue graft will then be used to seal up the perforation in the ear drum. A variety of methods is employed to apply and keep the graft material in place. The external ear canal is then packed with soft sponge-like gel foam and the incision closed with sutures. Lastly, a pressure bandage will be applied around the head over the ear after the operation is completed.

Common risks and complications:

Ringing in the ears

This occurs in many patients usually due to the packing in the ears. It usually recedes as the ear heals. However, occasionally it could be permanent. There is a chance that ringing in the ears which existed before the surgery may not be resolved after surgery.

Giddiness

This is common after anaesthesia but may also be due to manipulation of the ear-drum and bones that are connected to it. This is usually temporary and eventually it will resolve by itself.

Altered sense of taste

One of the nerves that transmit taste from part of the tongue runs closely behind the ear-drum. During surgery this nerve may be stretched or damaged or rarely, may have to be sacrificed. This may sometimes result in a change in taste, which is often temporary. The overall incidence may be as high as 15% but most resolve with time.

Failure to seal the perforation

There is a high chance of completely sealing the perforation. However, failure may be due to a variety of factors including the size and site of the perforation and whether the operation site gets infected. The risk of a persistent or recurrent perforation post-operation is between 11% and 16%. It is therefore important that you comply with the post-operative instructions strictly.

Uncommon risks and complications:

Facial nerve damage

There is another nerve that runs deeper in the ear. This nerve transmits fibres that control movement of one side of the face. Damage to this nerve is extremely rare as it is relatively far from the site of surgery. However, damage can occur particularly if the nerve runs in an abnormal location due to a congenital abnormality.

Wound infection and scarring

There is a small risk of bleeding and infection of the incision wound. Antibiotics are prescribed to prevent this. Wounds that get infected will take longer to heal and may result in poor scarring. Poor scarring can be corrected with further scar revisions.

Bleeding

There is a small risk of bleeding. A head bandage may be applied after the surgery to apply local pressure and prevent bleeding.

Deafness/hearing loss

Immediately after the operation, ear packing may be required and as a result, your hearing may be further impaired. This will usually improve when the packs are removed (normally about 2 weeks after the operation). There is a small risk of permanent hearing loss as a result of damage to the middle or inner ear.

What precautions must I take for the surgery?

Please inform your doctor if you have any medical illnesses. Before the procedure, please inform your doctor if any of the following are applicable:

1. You have a history of allergy or reaction to any medications, drugs, or food
2. You have a history of bleeding or clotting disorders
3. You are taking drugs (e.g. Aspirin, Clopidogrel, Warfarin, and Rivaroxaban) or supplements (e.g. Cordyceps, Ginkgo Biloba, and Lingzhi), that thin your blood, as these substances may affect blood clotting and increase the risk of bleeding. If you are taking any of these, your doctor will advise you accordingly.
4. You fall ill 2 weeks prior your surgery.

Duration of Surgery

Approximately: 1.5 - 2.5 hours

Duration of Hospital Stay

Average: 1 day

Mastoid dressing

There will sometimes be a bandage dressing placed around the head to apply local pressure to the wound and it will be removed by the surgical team on the following day.

Ear packing

Sponge like material placed into the ear canal during the surgery. As such, you will not be able to hear well from the operated ear for about 2 weeks until the ear packing is removed for you in clinic. There will be stitches placed behind the operated ear OR near the opening of the ear canal. A follow-up appointment is made 1 week after surgery during which the sutures are removed.

The ear should be kept strictly dry in the meantime to prevent infection. Antibiotic eardrops should be applied regularly as prescribed by your surgeon. A cotton ball may be used to prevent fluid from leaking out of the ear and can be changed regularly when stained, or when applying eardrops. Deeper packing within the ear canal SHOULD NOT be tampered with.

Avoid air travel until advised by your surgeon. During the initial month after surgery, avoid popping your ears, nose blowing, or pinching your nose when you sneeze as this may affect your eardrum repair.