[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [ENT](https://durgical.com/en/ent/) › [Procedures and technology](https://durgical.com/en/ent/areas/procedures/) › Myringoplasty and tympanoplasty

# Myringoplasty and tympanoplasty

- Procedure

The hole in the eardrum is closed with a graft and, if needed, the ossicles are rebuilt to restore hearing.

Updated Nov 12, 2026

**See it in 3D:** [Eardrum](https://durgical.com/en/anatomy/tympanic-membrane/) · [Malleus](https://durgical.com/en/anatomy/malleus/) · [Incus](https://durgical.com/en/anatomy/incus/) · [Stapes](https://durgical.com/en/anatomy/stapes/)

## Key points

- Myringoplasty = closing the eardrum; tympanoplasty = closing the eardrum and rebuilding middle ear conduction.
- The most common graft is temporalis fascia; tragal cartilage is preferred for large or recurrent perforations.
- A dry ear is operated on: active discharge is treated first; the closure rate falls with a wet ear.
- Wullstein described 5 types according to which ossicles remain; type I is myringoplasty with an intact chain.
- The goal is a dry, safe ear first, and better hearing second.

On this page

- The basics Key points
- What it is
- How it is done
- Wullstein types of tympanoplasty (what remains and where the graft goes)
- Memory aid
- Elsewhere in DurgiPedia

- Clinical Complications

- Treatment Next step / Initial management

- Safety Indications and contraindications

- Study Test yourself

- Connections Connections

## 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.

## Memory aid

One, two, three: malleus, incus, stapes; the number tells you what the graft rests on (or what is missing).

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ent/myringoplasty-and-tympanoplasty/)

## Elsewhere in DurgiPedia

- [Hearing: middle ear, cochlea and auditory pathway](https://durgical.com/en/physiology/hearing-middle-ear-cochlea-and-auditory-pathway/)
- [Otoscopy and the Rinne and Weber tests](https://durgical.com/en/clinical-exam/otoscopy-and-the-rinne-and-weber-tests/)

## Connections

## See it in 3D 4

The structures of Durgical's 3D anatomy where it is found.

- [Eardrum](https://durgical.com/en/anatomy/tympanic-membrane/)
- [Malleus](https://durgical.com/en/anatomy/malleus/)
- [Incus](https://durgical.com/en/anatomy/incus/)
- [Stapes](https://durgical.com/en/anatomy/stapes/)

## Related 3

- [Tympanometry and the acoustic reflex](https://durgical.com/en/ent/tympanometry-and-the-acoustic-reflex/)
- [Mastoidectomy: cortical, radical and modified radical](https://durgical.com/en/ent/mastoidectomy-cortical-radical-and-modified-radical/)
- [Myringotomy and ear tubes (tympanostomy)](https://durgical.com/en/ent/myringotomy-and-ear-tubes/)

## Related conditions 3

- [Tympanic membrane perforation](https://durgical.com/en/conditions/tympanic-membrane-perforation/)
- [Otitis media with effusion and chronic suppurative otitis media](https://durgical.com/en/conditions/otitis-media-with-effusion-and-chronic-suppurative-otitis-media/)
- [Otosclerosis](https://durgical.com/en/conditions/otosclerosis/)

## In Pharmacology 2

- [Ciprofloxacin](https://durgical.com/en/pharmacology/ciprofloxacin/)
- [Paracetamol](https://durgical.com/en/pharmacology/paracetamol/)

[← All of ENT](https://durgical.com/en/ent/)

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)](https://www.ncbi.nlm.nih.gov/books/NBK565863/) (StatPearls Publishing, NCBI Bookshelf, 2023); [Tympanic Membrane Perforation (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK557887/) (StatPearls Publishing, NCBI Bookshelf, 2026); [Eardrum repair](https://medlineplus.gov/ency/article/003014.htm) (MedlinePlus, U.S. National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ent/myringoplasty-and-tympanoplasty/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/myringoplasty-and-tympanoplasty/