Myringoplasty

This operation is used to close a hole in the eardrum. The main reason for doing this is to prevent recurrent infection. The main nuisance with a hole in the eardrum is the person may have a degree of hearing loss and sometimes they expect that the hearing will be improved after the hole is closed. This is not always the case, indeed if the hearing is improved it should usually be regarded as a bonus rather than something to be expected. A hole in the ear drum does not always has to be repaired and some people are busy leading their lives with a small hole, however in a young person it does preclude certain forms of employment and sports e.g. scuba diving and in the more elderly it may prevent the wearing of a hearing aid if recurrent infection is the result. There are many ways of doing the operation but the commonest is to take a piece of thin tissue from under the skin covering one of the muscles (temporalis fascia) and putting this underneath the ear drum. The ear is approached from either an incision behind the ear or a small incision that comes from inside the ear canal out to the front of the ear. After the operation a dressing will be put in the ear canal and sometimes a fresh dressing covering the ear itself. My personal practice is to put in a sponge dressing in the ear canal, which we keep wet with antibiotic drops for a fortnight. If there is a pressure dressing it will usually be removed the day after the operation and there may be some blood stained cotton wool in the outer part of the ear canal. This can be removed and changed as necessary. A blood stained ooze may come out of the ear for several days afterwards but if it becomes yellow or bad smelling one might suspect an infection which although unusual is possible. Under these circumstances you should contact the surgeon immediately. I usually review the patients after two weeks and remove the sponge dressing and then again in six weeks by which time it should be possible to tell whether the graft has been successful or not and we would usually do a post operative hearing test at that point. Complications - complications are rare but some discharge from the ear is to be expected as above. If however the ear becomes painful and the discharge becomes more profuse rather than less one should seek the advice of a Doctor immediately.

The success rate of the graft depends on many factors and no body can claim 100% success in every operation. My own success rate for closing the hole in a long term is approximately 80%. I believe this is not dissimilar to most other ENT surgeons practice in the UK. Any operation on the ear carries a small but real risk that the hearing will be made worse rather than better, although this has never happened to me yet (touch wood) after a simply myringoplasty this remains a theoretic possibility. No patient should have an ear operation without realising that this complication could occur.


Facial nerve weakness or palsy

Again this is a dreaded complication of any ear surgery. The immediate onset of a nerve weakness after ear surgery may be due to the effect of the local anaesthetic or bruising of the nerve or more seriously due to permanent damage. None of these are common occurrences. If the weakness is due to local anaesthetic it will wear off in a few hours but bruising may take some days or weeks to recover. Rarely is the onset of weakness may be delayed by a few days or even a week but under these circumstances the prognosis for recovery is good. Permanent damage to the facial nerve is fortunately rare and can be minimised by careful appreciation of the anatomy possibly enhanced by pre operative scanning such as CT, and the use of intra operative nerve monitors. If it does occur as a result of severe trauma then the situation can be to a certain extent redeemed but then long-term weakness is likely to result. This again is exceeding unlikely in a simply myringoplasty but and a rare but unfortunate complication of mastoid surgery which involves drilling away the bone of the mastoid.