Myringoplasty and tympanoplasty
- Procedure
The hole in the eardrum is closed with a graft and, if needed, the ossicles are rebuilt to restore hearing.
What it is
Myringoplasty repairs only the eardrum perforation. Tympanoplasty is broader: it clears middle ear disease and rebuilds the sound-conducting mechanism (eardrum and ossicles). Rebuilding the ossicles is called ossiculoplasty. The most common graft is temporalis fascia; perichondrium or tragal cartilage are also used. Surgery is done on a dry ear, through the canal or from behind the ear, with a microscope or an endoscope.
Indications and contraindications
- Eardrum perforation that does not close on its own within 3 months (traumatic or chronic otitis), with conductive hearing loss or repeated discharge.
- Inactive mucosal (central perforation) chronic otitis media with a dry ear.
- Ossicular erosion causing significant conductive hearing loss; together with mastoidectomy in cholesteatoma.
- Wish to swim without infections or to use a hearing aid without discharge.
- Contraindications: actively discharging ear, untreated nasal or pharyngeal infection, only hearing ear (relative), poor general condition.
- Small traumatic perforations usually close on their own: wait and keep water out of the ear.
How it is done
- Before: audiometry (air-bone gap), a dry ear for several weeks and oto-endoscopy of the perforation.
- Paper patch test in clinic: if hearing improves with the patch, the ossicular chain is probably intact.
- Transcanal, endaural or postauricular approach; a temporalis fascia or cartilage graft is harvested.
- The perforation edges are freshened by removing the epithelial rim so that the graft takes.
- The tympanomeatal flap is raised, the ossicular chain checked and middle ear disease cleared.
- If an ossicle is missing, it is rebuilt with the patient's own bone or a prosthesis.
- The graft is placed under (underlay) or over (overlay) the eardrum remnant and supported with absorbable sponge.
- After: a dry ear, no forceful nose-blowing or straining; follow-up audiometry after some months.
Wullstein types of tympanoplasty (what remains and where the graft goes)
| Type | Middle ear situation | Reconstruction |
|---|---|---|
| I | Perforation with an intact ossicular chain | Graft on the malleus (myringoplasty) |
| II | Eroded malleus | Graft on the incus or the malleus remnant |
| III | Malleus and incus absent, stapes intact and mobile | Graft on the stapes head (columella) |
| IV | Only the mobile stapes footplate remains | Graft shielding the round window; the footplate is left exposed |
| V | Fixed stapes footplate | Fenestration of the lateral semicircular canal (Va) or stapedectomy (Vb) |
Complications
- Graft failure with residual perforation.
- Persistent conductive hearing loss or, rarely, sensorineural hearing loss.
- Taste disturbance from handling the chorda tympani.
- Transient vertigo.
- Graft lateralisation or canal stenosis.
- Cholesteatoma pearl from epithelium trapped under the graft; rarely facial nerve injury.
Next step / Initial management
- Before referral: describe the perforation (central or marginal, size, dry or wet) and request audiometry.
- If the ear is discharging, treat first with canal cleaning and quinolone ear drops; keep the ear dry.
- After surgery: dry ear, no forceful nose-blowing or flying until the surgeon allows it; simple analgesics such as paracetamol.
- Refer on a routine basis to ENT any perforation that does not close within 3 months or with recurrent discharge.
- Refer urgently, the same day, if after surgery there is severe vertigo with vomiting, sudden loss of hearing, facial palsy or fever with pain.
Test yourself
Think of the answer, then tap the question to see it.
What is the difference between myringoplasty and tympanoplasty?
Myringoplasty only closes the eardrum perforation; tympanoplasty also clears the middle ear and rebuilds sound conduction, including the ossicles.
What is the most commonly used graft to close an eardrum perforation?
Temporalis fascia; perichondrium and tragal cartilage are alternatives, the latter useful for large or recurrent perforations.
In a Wullstein type III tympanoplasty, what does the graft rest on?
On the head of the stapes, when the malleus and incus are missing but the stapes is intact and mobile.
A patient with a central perforation and active discharge asks for surgery. What is done first?
The ear is dried with cleaning and topical ear drops; tympanoplasty is planned on a dry ear because the graft takes better.
Elsewhere in DurgiPedia
Connections
In Pharmacology2
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Tympanoplasty (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2023); Tympanic Membrane Perforation (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Eardrum repair (MedlinePlus, U.S. National Library of Medicine, 2026).
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