Myringoplasty

A myringoplasty is a surgery performed by an otolaryngologist to repair a hole in the eardrum. In this surgery, the hole is repaired by placing a graft made of either a small piece of tissue from elsewhere on the body, or a gel-like material.

Your child’s eardrum, also called the tympanic membrane, is located between his outer ear and middle ear. This thin membrane vibrates in response to sound waves and plays a role in hearing.

A hole can form in this membrane from a severe ear infection; an ear tube; or from an injury, such as an object poking in the ear canal. A child may notice this hole if he blows his nose and hears air comes out, if he experiences hearing loss, or if he sees fluid has drained onto his pillow overnight.

In about 90 percent of cases, a hole in the eardrum heals without treatment. Holes that don’t close on their own within three months are vulnerable to infections and may cause temporary hearing loss. In these cases, surgery is required.

In about 95 percent of the myringoplasties performed at CHOP, the surgery successfully fixes the hole, reduces the risk of future infections, and restores or greatly improves hearing.

Other types of surgical approaches to eardrum repair include: a tympanoplasty, which involves a more extensive rebuilding of the ear drum and removing scar tissue, and an ossiculoplasty, which repairs or replaces the three tiny bones behind the ear drum, called ossicles.

Your child’s primary care provider can determine whether your child has a hole in his eardrum by using an instrument called an otoscope. If your primary care provider has any concerns about the hole not healing or being associated with repeat ear infections or hearing loss, the primary care provider will refer your child to an otolaryngologist.

To determine if your child is a good candidate for myringoplasty, the otolaryngologist will do a thorough exam of your child’s ear and conduct hearing tests. Based on the results of this evaluation, myringoplasty may be recommended.

In general, your child may be a candidate if he:

• Has a hole in his eardrum that hasn’t healed within three months
• Has repeat ear infections, especially if these repeat infections caused the hole in the first place. That might signal a Eustachian tube problem that prevents the hole from healing on its own.
• Has a hole in the center of his eardrum
• Wants to swim without waterproofing his ear. Water entering the hole can lead to infections.

A CHOP otolaryngologist typically performs this procedure at one of CHOP’s outpatient treatment facilities. Your child will lie on the table with his face to one side. The surgeon will use general anesthesia in this simple procedure that usually lasts between 10 and 30 minutes. During myringoplasty, the surgeon will:

• Enter the ear either through an incision behind the ear or through the ear canal, depending on the size and location of the hole and the size of your child’s ear canal
• Use an instrument to “freshen” the edge of the hole which triggers the body’s own natural healing process
• Place a graft made of tissue from beneath his skin or a gel foam or paper-like material
• Fill your child’s ear with cotton packing that will stay in his ear for about a week
• Apply a bandage across the outside of the ear to protect his ear canal

After the myringoplasty procedure, your child may feel groggy or even nauseous from the anesthesia. He can recover with his parents at his side in the post-operative unit. He’ll likely feel better within a few hours, or by the time he goes home, which is usually on the day of surgery.

Your child will be prescribed antibiotic ear drops to prevent the risk of infection; the drops go into the ear canal, requiring a momentary removal of the packing.

Once home, your child should rest. He can eat bland foods and drink clear liquids as he feels up to it. He can return to normal activities at his own pace, usually within a couple of days. Sneezing with his mouth closed and nose blowing are to be avoided for several weeks. Your child will also have to keep his ear dry, so showers are to be avoided until the doctor gives the okay. Your child will also have to avoid sports for several weeks; swimming may be discouraged for several weeks.

He might have mild ear pain and soreness for the first few days, but the discomfort should pass within five days. Acetaminophen can help, if the doctor prescribes it. He may also experience popping, clicking or other sounds in his ear, which are normal and will go away within a few days.

Ear drainage can be cleaned outside the ear bandage for the first several days. Your doctor or nurse will give you instructions on how this is to be done. Nothing should be put into the ear canal except the appropriate amount of antibiotic ear drops.

At the follow-up visit, usually four to six weeks after surgery, your child’s doctor may remove the packing. Be careful not to touch the packing until then. There are no stitches to be removed at the follow-up visit; they’ll dissolve on their own.

Most children recover quickly from a myringoplasty. However, if you have any concerns about your child’s recovery, or if unusual symptoms develop, call your child’s doctor immediately. Call if your child shows signs, such as:

• Bright red blood
• Fever
• Severe nausea
• Severe ear pain
• Breathing trouble or rashes
• Weakness of the face
• Ringing of the ear, known as tinnitus
• Dizziness that persists for more than a few hours

When your child has a hole in his eardrum that must be surgically repaired, it’s important to find an experienced specialist, like the otolaryngologists at The Children’s Hospital of Philadelphia. Even the relatively basic myringoplasty procedure can have varying rates of success depending on the extent of eardrum damage and the surgeon’s experience. At CHOP, our surgeons perform many myringoplasties each year, delivering patients and families great results. Our convenient surgery center’s located throughout the region make it possible for your child to have this simple procedure done close to home, without traveling into Philadelphia.