A tympanoplasty is the surgical repair of a hole in the eardrum, which is known as a perforated eardrum. It is an inpatient procedure done under general anesthesia (or sometimes under local anesthesia), and takes two hours or more. Tympanoplasty is often done in children, but adults may in some cases require the procedure as well. Here's everything you need to know before going in for your procedure.
What Is Tympanoplasty?
In a tympanoplasty, the surgeon patches a hole within the eardrum that isn't healing by itself. The surgery is done either through the ear canal or through an incision at the back of the ear. A tissue graft is taken from the patient, usually from behind the ear, and used as the patch. A synthetic material graft may be used also. It is held in place with packing material.
Contraindications
Your surgeon will weigh the potential risks and benefits of a tympanoplasty before recommending your procedure. If you're not a good candidate for general anesthesia, other options will need to be explored to ensure your safety.
Anesthesia risks are higher for patients who have:1
Potential Risks
As with any surgery, there is a risk of bleeding and infection after tympanoplasty. However, because tympanoplasty is done on such a small area, complications are relatively rare. Complication rates can be minimized by following post-surgical instructions.
Other potential risks from tympanoplasty include:2
If the incision is bleeding, oozing, or swelling, call the healthcare provider. Fevers over 100.4 degrees Fahrenheit or increased pain could be signs of an infection and should be addressed right away.
Because tympanoplasty is performed under general anesthesia, there is always the risk of complications, including heart and breathing problems.3 The anesthesiologist will review these risks with you before the procedure.
Purpose of a Tympanoplasty
Ear infections, accidental injury, or the placement of ear tubes can cause a perforated eardrum. If it's been more than three months and the hole hasn't healed on its own, you may need a tympanoplasty to surgically close it up.
The purpose of a tympanoplasty is to fix the membrane, improving hearing and providing relief as a result.3 Tympanopasty will also allow the patient to swim, which would normally be avoided when there is a hole in the eardrum.
Call your healthcare provider or 911 if you are experiencing a medical emergency.
How to Prepare
If you're having a tympanoplasty, be sure to follow your surgeon's instructions to avoid any delays in your ability to have the operation as scheduled. Tympanoplasty is an invasive procedure, so it's imperative to let your healthcare provider know about any medications or supplements you're taking, as well as even accidental last-minute snacks or drinks, that may interfere with your safety during the operation.
If you're a parent with a child who is having a tympanoplasty, you'll want to prepare them in a way that's developmentally appropriate for their age. Your child should be given some idea of what to expect without hearing unnecessary details that may scare them.
Talk to your pediatrician for advice on how to discuss surgery with your child. A physical exam will be required during the week or two before your child's tympanoplasty to make sure they're healthy enough for surgery.4
Location
Your tympanoplasty will be completed inside a hospital setting, since general anesthesia is ofteen required.5
What to Wear
It's best to wear clothing that's loose, comfortable, and easy to remove. You'll be given a hospital gown to wear during your procedure. Pack clothes that don't need to be pulled over your head for easier access to your surgical dressing after your procedure. Zip or button-up tops will help you avoid brushing against your ear as it heals.
Don't wear any jewelry to your operation, especially earrings. Your surgeon will provide more specific instructions if make-up, deodorant, nail polish, or other items are prohibited on your surgery day.
Food and Drink
Food and drink will need to be restricted before surgery because of the general anesthesia. Required fasting time varies based on the age of the patient. Adults are generally advised to avoid all food and drink starting at midnight on the eve of surgery.
This rule also applies to children over 1 year old. Clear liquids may be consumed up to two hours before surgery.
Why You Can't Eat or Drink Before Surgery
What to Bring
If you'll need to stay at the hospital after your tympanoplasty, pack lightly and leave valuables at home. Bring the items that you'll want to have for an overnight stay at the hospital (such as your toothbrush, a change of clothes, slip-on shoes, deodorant, and glasses if needed). Take any necessary paperwork, personal identification, and insurance information for pre-surgery forms that may be required.
Pre-Op Lifestyle Changes
Making an effort to be as healthy as you can before surgery will give you the best chances of a speedy recovery. If you're a smoker, try to quit as far in advance as possible before your surgery. Eating well, sleeping enough, and getting a handle on chronic conditions (like diabetes and high blood pressure) will prepare your body to withstand anesthesia and the stress of your operation.6
Quitting Smoking Can Improve Surgical Outcome
What to Expect on the Day of Surgery
If you're anxious about your upcoming tympanoplasty, knowing what to expect can help ease your nerves. Here's how the process is likely to play out.
Before the Surgery
Immediately before the surgery, there shouldn't be much left to do. You may have to complete some last-minute paperwork, meet with the anesthesiologist to review the plan for sedation, and have your vital signs checked by the nursing staff.
Always be honest with your surgeon in answering any preoperative questions about new symptoms (such as a recent fever or cold), medications, supplement usage, and the last time you had something to eat or drink.
During the Surgery
During a tympanoplasty, your surgeon will cut behind your ear to reach the ear canal, or work through your ear canal directly. After lifting your eardrum, the hole is filled using a graft of your own cartilage, a connective tissue graft, or a synthetic material graft. Packing is placed around the graft to keep it secure. It takes an average of two hours to complete a tympanoplasty procedure.7
If the bones of your middle ear (ossicles) are also damaged, a prosthetic device can be inserted to replace them. Your healthcare provider will choose either a total or partial ossicular replacement prosthesis.5
After the Surgery
Unless there are complications, you should be released to go home after spending one night of observation in the hospital following your procedure. Sometimes you may even be discharged and allowed to go home the same day as the surgery. Ask your surgeon what to plan for, as some tympanoplasty patients are released the same day once their vital signs are stable (especially children).
Someone will need to drive you home, whether you go home the same day or the next day, since it takes several hours for the anesthesia to fully wear off before it is safe to resume driving.
Once you're cleared to go home, you'll be given discharge instructions. It's crucial to follow your surgeon's advice and take it slow, even if you're feeling well. Doing too much, too fast, can hinder your body's ability to heal, prolonging the recovery process.
Strenuous exercise, straining, and heavy lifting (anything over 20 pounds) should be avoided for at least two weeks.7 You should also avoid traveling by airplane after the surgery until your surgeon says it is safe to fly. To reduce swelling, elevate the head of your bed when you sleep. It can also take some time for hearing to improve after a tympanoplasty, so be patient with your results in the early days of healing.
Recovery
After a tympanoplasty, you should plan to take one to two weeks off from school or work for recovery.5 Your healthcare provider will schedule you for a follow-up visit about a week after the procedure to check for signs of infection and remove your stitches. If you're healing well, you'll be cleared to get back to your usual activities.
Follow-ups will be scheduled to evaluate your body's healing and remove any packing material that doesn't dissolve on its own.
Healing
Some drainage is normal in the first three to five days after a tympanoplasty. A sterile cotton ball can be used to help keep the area dry. Your healthcare provider will provide ear drops for use following surgery.
Swimming and flying in an airplane are prohibited immediately after tympanoplasty until your healthcare provider says otherwise. Do your best to keep incisions dry as they heal.
Persistent vomiting and difficulty standing or walking should be reported immediately to your surgeon's office.
Long-Term Care
It can take two to three months after tympanoplasty before a full recovery is achieved. During this period, hearing will begin taking place as the packing material fully dissolves over time.4 Your healthcare provider will do a complete hearing test eight to 12 weeks after surgery.
Additional surgeries or treatments are unlikely after a tympanoplasty. Follow your surgeon's instructions to ensure a safe recovery, and you should be back to feeling like yourself (only better) in no time.
