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Tympanoplasty is surgery that closes a long-standing hole in the eardrum with a graft taken from the patient's own tissues — usually temporalis fascia, a thin piece of ear cartilage, or periosteum. The eardrum is a thin membrane separating the ear canal from the middle ear and transmitting sound vibration to the hearing bones, so a persistent perforation leaves the middle ear open to the outside environment. The two main goals are to stop repeated infection and discharge every time water enters the ear, and to recover the part of the hearing lost because of the hole. The usual causes are chronic middle-ear infection, a perforation that failed to heal after an acute infection, direct injury, damage from attempts to clean the ear with sticks or instruments, or a hole that persisted after a ventilation tube fell out. What the operation does not do must be clear before consent. It **does not repair sensorineural hearing loss** arising from the cochlea or the hearing nerve, so any expected gain is limited to the conductive component caused by the perforation. It does not necessarily treat tinnitus, which may continue. If the hearing bones are eroded, an additional ossicular reconstruction may be needed in the same or a later session. The graft can also fail and the hole return, particularly with Eustachian tube dysfunction, continued smoking, or uncontrolled nasal inflammation. Candidacy is decided by endoscopic examination of the ear and an audiogram, sometimes with a CT scan, together with assessment of the nose and Eustachian tube, because graft success depends on a ventilated middle ear. Surgery is usually postponed until the ear is dry and infection has settled. The specialty concerned is ear, nose and throat surgery, or dedicated otology.
The perforation is inspected with an otoscope or endoscope to record its size, position and the state of the edges, and an audiogram distinguishes conductive from sensorineural loss. A CT scan may be requested when eroded ossicles or more extensive middle-ear and mastoid disease is suspected.
The operation is usually performed under general anaesthesia, occasionally under local anaesthesia with sedation. Access may be entirely through the ear canal with an endoscope for small perforations, or through a discreet incision in front of or behind the ear for larger ones.
The graft is taken from the patient's own tissue: temporalis fascia above the ear, or a thin slice of cartilage with its perichondrium from the outer ear. Foreign material is not used in routine cases, which reduces the risk of rejection and improves take.
The edges of the hole are freshened to stimulate healing, the hearing bones are inspected and tested for mobility, then the graft is placed under the remaining drum or between it and the bony annulus and supported with absorbable material that holds it until it heals.
The ear canal is packed with dressing or sponge that is removed in clinic after one to three weeks, and an external dressing is applied when an incision was used. The patient is woken, observed and usually discharged the same day with strict instructions to keep the ear dry.
Tell your surgeon about every medicine and supplement, especially blood thinners and aspirin, and stop nothing without instruction. Mention drug allergies, any dizziness, tinnitus or hearing loss in the other ear, and any previous ear surgery. Call the clinic if the ear discharges or becomes infected before the date, as surgery is usually postponed until the ear is dry. Treat nasal blockage and allergy if present, because middle-ear ventilation largely decides whether the graft takes. Stop smoking; it is one of the strongest causes of graft failure. Follow the anaesthetist's fasting instructions, and wash your hair the day before. Bring your audiogram and reports, arrange a driver, and plan one to two weeks off depending on your work.
**Keep the ear completely dry** until your surgeon allows otherwise: no swimming, no diving and no water in the canal while showering; use a plug or cotton with petroleum jelly as advised. Do not blow your nose forcefully, sneeze with your mouth open, and avoid heavy lifting, strenuous effort and air travel until permitted. A feeling of fullness, muffled hearing, clicking and brief mild dizziness are normal until the packing is removed, so do not judge your hearing until several weeks after removal. Take medicines and drops as prescribed and keep every follow-up appointment. **Seek care immediately for: severe persistent vertigo or vomiting, weakness or numbness of the face on the same side, fever with pain and purulent discharge, sudden hearing loss or a new severe tinnitus, or continuous bleeding from the ear.**
Usually 45 to 120 minutes depending on the technique, with same-day discharge in most cases.
Dr. Marwan Ibrahim Al Halalmeh is an ENT specialist with Jordanian Board certification and higher specialty training. Following work at the Royal Medical Servic…
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