Ear drum repair (tympanoplasty)

What is the tympanic membrane?

The ‘tympanic membrane’ is the eardrum. It is a partition between the external ear canal and the middle ear. The middle ear is an air-filled space containing three important ear bones. Sound reaching the ear drum vibrates the ear bones and transfers the energy towards the inner ear.

The ear drum protects the structures in the middle ear by providing a water-proof barrier to the outer world.

What causes a perforation (hole in the eardrum)?

The commonest cause of a perforation is infection. After an ear infection results in a perforation, the ear drum usually heals on its own. Occasionally, a hole is left behind that can only be fixed by surgery.

Trauma is another cause of perforations, but these almost always heal on their own.

What problems can my child have with a perforation?

Recurrent infections

Infections occur as the perforation is a direct link to the outside world, allowing substances to enter the middle ear along with water and lead to infections.

Hearing loss

A perforation can reduce the transfer of sound energy to the inner ear resulting in a hearing loss. This is usually mild. Hearing loss that is more pronounced may indicate a problem with the bones of hearing.

What is a tympanoplasty?

A tympanoplasty is a surgical procedure that repairs or reconstructs the eardrum (tympanic membrane) to help restore normal hearing. This procedure may also involve repair or reconstruction of the small bones behind the eardrum. Both the eardrum and middle ear bones need to function well together for normal hearing to occur.

Why does my child need a tympanoplasty?

A tympanoplasty is recommended when the eardrum is torn (perforated) or sunken in (retracted), which may be associated with hearing loss.

Surgery is usually suggested if a child with a perforated eardrum is having recurrent infections, or if they wish to have a waterproof ear for swimming. Hearing loss alone is usually not a reason for considering surgery, as hearing improvement with surgery may be variable.

This operation can be performed whenever your child is ready to have it done. Although in cases where there is a significant infection then this operation may be necessary to prevent more significant damage to the ear and the surgery may need to be performed more urgently.

Is there an alternative to the operation?

It is not always essential to undergo surgery, especially if your child is not having problems with recurrent infections. If surgery is not performed, you can help to reduce the risk of repeating ear infections by keeping the affected ear dry. This can be done using ear plugs when washing your child’s hair, during bathing, swimming or showering. For swimming, the use of a swimming cap or ear protectors in addition to ear plugs is useful. Custom made swimmer’s moulds can be obtained from our audiology team to reduce the chances of water getting in the ear.

Your surgeon may also suggest the use of hearing aids if your child’s hearing test has shown a reduced in their hearing, and our time can provide a copy of your child’s hearing test to document any hearing deficiency.

How successful is tympanoplasty?

We are able to create a waterproof ear is obtained in around 9 out of 10 cases, with 9.5 to 10 people having a reduction in infections. Roughly 7 out of 10 patients will have an improvement in hearing.

Risks of tympanoplasty surgery

Hearing loss

The primary aim of a tympanoplasty is repair of the ear drum to avoid ear infections; hearing improvement is usually a secondary goal and may not always be achievable. Some hearing loss (more common if small bones have been repaired) may still be present after the procedure.

There is a very small chance of losing the hearing completely and this would have been discussed with you before you consent for your child to undergo this procedure.

Dizziness

Your child may be slightly off balance and this is often due to the packing used after the operation. This usually settles down.

Persistent dizziness and imbalance after surgery is rare, although more common if the small bones have been repaired.

Tinnitus

After surgery, tinnitus and other strange sounds are common while the packing material is in place. This usually settles down.

If your child has tinnitus before surgery it may remain the same after the procedure.

Graft failure

Because this operation involves grafting using your child’s own tissue, very rarely this tissue will not survive long enough for the hole in the eardrum to heal completely. In this case, another operation may be necessary. Because the success rate of this surgery is around 80 percent, re-operation also has a very high success rate.

Taste disturbance

The nerve for taste passes just underneath the ear drum, and may be manipulated during surgery. This may lead to a transient change in taste that is often described as a “metallic taste” and very rarely persists beyond 3 months.

Transient facial nerve weakness

A large nerve that supplies the muscles of the face runs through the middle ear. Rarely, there can be transient weakness of the face due to the anaesthetic medicines applied to the ear.

What time will my child have their operation?

You will be informed whether your child’s operation is in the morning or afternoon when you are contacted by the hospital to confirm a date for surgery.

What time should I bring my child to the ward?

You will receive a letter telling you the date of your child’s operation and the time you need to bring them into hospital.

Usually, if your child’s operation is in the morning you will be asked to arrive on the admission ward at 7.45am, and if your child’s operation is in the afternoon you will be asked to arrive on the admission ward at 11am or 12pm (midday).

What shall I do if my child has a sore throat, a temperature or is unwell a few days before or the day of their operation?

You need to telephone the hospital on 0114 271 7286 and tell us. You will then be told whether it would be safe for your child to have their operation as planned.

On the day of the operation

What time should I give my child their last food and drink?

If your child’s operation is in the morning they can eat and drink until 2.30am, and then have clear fluids (water, diluted squash and fruit juice without pulp) until arrival on the ward. Please note they should not have chewing gum or boiled sweets either.

If your child’s operation is in the afternoon they must have finished their breakfast by 7.30am, and then have clear fluids (water, diluted squash and fruit juice without pulp) until arrival on the ward.

What will happen when we arrive on the ward?

An anaesthetist will visit your child and make sure they are fit for their operation. They may prescribe some anaesthetic cream for your child’s hand so that it does not hurt when a tiny tube is inserted into their hand to let the anaesthetic to be given. This tube is inserted when your child is in the anaesthetic room.

The surgeon will also see you and your child before their operation.

A nurse will take your child’s temperature, weigh them and put a name band on their wrist. Your child will be asked to put on a theatre gown or their pyjamas. If your child has long hair they will need to tie it up in a ponytail with a non-metallic band. All jewellery and nail varnish must be removed. The nurse will then apply the magic cream to their hands.

Your child will either walk or be taken to theatre on a trolley. 1 parent or carer may go to the anaesthetic room and stay with them until they are asleep.

How long will the operation take?

Your child will be away from the ward for about 2 to 3 hours altogether.

What happens during the tympanoplasty?

The surgery is done under general anaesthetic.

The surgeon makes a small cut either behind or in front of your child’s ear and the eardrum is then carefully exposed. Alternatively, this may be performed without any external cuts with a telescope directly through the ear canal. A piece of tissue called a graft is then placed underneath or within the eardrum to act as a scaffold for the eardrum to grow on.

Usually, the surgeon will use skin or cartilage from your child’s body from either behind or in front of the ear.

Alternatively, an artificial or animal graft may be used. If this is the case, the surgeon would discuss this with you when planning the operation.

Careful steps are taken to preserve hearing and not to damage the facial nerve. If needed, reconstruction of the middle ear bones may also be performed at this time.

The surgeon may pack the ear canal with a material to keep the repair in position and reduce the chances of infection. Depending on the approach, a head bandage may be used, which is removed the next day.

Will my child have any stitches?

Yes, but these usually dissolve after a few weeks. If they need to be removed this can be done at your GP practice 5 to 7 days after the operation.

After the operation

Will I be there when my child wakes up?

The escort who takes you and your child to the anaesthetic room will tell you how you will be contacted so that you can be with your child.

Will my child have any pain?

Your child will have been given some strong painkillers in theatre before they wake up.

They may have some pain later but the nurse will give them some medication to ease this.

When can my child have something to eat or drink?

Your child can have their first drink as soon as they wake up after the operation. Once they have had a drink the nurse will tell you when they can have something to eat. This is usually a slice of toast or a biscuit.

When can my child go home?

This depends upon the opinion of your child’s surgeon and also how quickly your child recovers from their operation. Your child may be able to go home the same day or may stay in hospital for 1 night.

How do I look after my child at home?

You will be given painkillers which you should give regularly to your child for the first 3 days and then gradually reduce the amount you give as your child’s pain reduces.

A small amount of discharge from the ear is normal.

You must keep your child’s ear dry.

If the packing material starts to fall out don’t worry, as the surgeon has usually put more than one piece in.

Do not attempt to push the pack back in; if it is hanging from the ear canal cut it off carefully using a pair of scissors.

When can my child go back to school?

We usually suggest that your child has 2 to 3 weeks off from school, to avoid infections and allow the ear to heal.

Will my child be able to hear after the operation?

Your child will not be able to hear very well whilst the packing is in their ear.

Will I need to see the ENT doctor again?

Yes. You will receive an appointment either to be seen in the outpatients clinic a few weeks after your child’s operation or an appointment to be admitted to the Day Care ward for your child to have packing removed under a short general anaesthetic.