The eardrum can have a hole or defect present from a variety of reasons including trauma (Q-tip, hairpin, slap to the ear, diving accident, etc.) Otherwise, a severe acute infection of the middle ear or a long-standing problem with the eustachian tube can result in a hole (perforation) of the eardrum.
In most cases, the eardrum can be easily repaired by an operation called Tympanoplasty. The techniques vary but the most common technique used in this practice is a trans-canal tympanoplasty with a medial fascia graft. This means that the eardrum is approached through the ear canal and the incisions are in the ear canal itself. An incision to obtain a graft (muscle covering called fascia) is made just above the ear at the hairline. The incision will not show appreciably.
The damaged eardrum is carefully examined and prepared for the graft. The middle ear is examined for other abnormalities while the patient is asleep. Sometimes, skin cysts and middle ear boney abnormalities are diagnosed since the middle ear is exposed very well during the procedure. The graft is placed medial to the existing eardrum remnant, closing the hole in the eardurm. This is very akin to repairing a hole in a tire with an “inner patch.” The graft is secured with absorbable packing and the operation is finished. Generally, the only bandage is a cotton ball and bandaid.
In less common cases, the eardrum is approached with an incision behind the ear. This is done for difficult to access eardrums or in the case that a mastoidectomy also needs to be done. This is called a post-auricular approach and when the patient awakes, he has a pressure bandage on the ear with a plastic ear cup and this is removed at home on the following morning.
The Tympanoplasty procedure is safe and effective. Patients go home on the same day and the pain is minor. The complications of the procedure include repair failure, taste changes, hearing loss, continued ear infections. The complication rate, however, is low.