Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Monroe Carell Jr.
Children's Hospital
at Vanderbilt
2200 Children's Way
Nashville, TN 37232


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Eardrum Perforation

 

What is an eardrum perforation?

It is a hole in the eardrum, a thin membrane deep in the ear canal. It vibrates when sound waves enter the ear, transferring sound energy into the inner ear.

A hole in the eardrum can be the result of a bad ear infection, a surgical procedure like placement of an ear tube, or from trauma such as a cleaning swab jabbed deep inside the ear canal. This is one of many reasons to avoid using any cotton swab to clean your ears!

Do eardrum perforations cause hearing loss?

This is almost never the case. In fact, many perforations don't even cause a temporary hearing loss.

The effect a perforation has on hearing depends on the size of the hole and where it is located on the eardrum. Most perforations are relatively small and in areas that don't much affect hearing. Even so, large perforations and even some smaller ones can cause a temporary hearing loss. They do not cause complete deafness, however. The degree of hearing loss varies and usually returns to normal (or very close to normal) after the perforation is fixed.

Should all eardrum perforations be fixed?

Some perforations do not require any special treatment. When an eardrum perforates during a bad ear infection, the infected ear fluid usually drains out through the hole. After a few days, the hole will usually close by itself. Sometimes the infection lingers for a while and may need additional treatment with medicines or ear drops. After the infection is finally clear, the hole may still close by itself.

If a perforation has been present for more than three months without infection or drainage it is unlikely to close by itself. At this point, your doctor may recommend having the hole closed surgically. The decision to surgically close a perforation is sometimes a difficult one to make. It depends on a variety of factors, including the patient's age, history of infections, problems with the other ear, and the degree of hearing loss (if any). A pediatric ear, nose, and throat (ENT) specialist can help you decide if it's the right time to repair your child's eardrum perforation.

How is an eardrum perforation repaired?

There are two basic of ways to repair an eardrum perforation. Your ENT doctor will discuss which method is best for your child. All types of repairs are performed by an ENT surgeon in an operating room under general anesthesia, which is very safe. The medical team will carefully monitor your child during the procedure.

Patch myringoplasty (mer-RING-go-plass-tee) - This is the simplest kind of repair. The eardrum perforation is covered with a material that temporarily plugs the hole. This encourages the body's normal healing processes to close the hole. The material can be a piece of paper, a piece of gelatin (our preferred method), or even a piece of fat taken from the ear lobe. The procedure usually takes between five and 10 minutes. However, it is only useful for relatively small holes in the center of the eardrum.

Tympanoplasty (tim-PAN-o-plass-tee) - This is a more common, and more lengthy, procedure. The hole is patched using material that replaces the missing eardrum portion. Sometimes this material is cartilage taken from the outer part of the ear (don't worry, no one will ever know it's missing). More often, the material is a connective tissue, called fascia (FASH-ah), removed from underneath the skin behind the ear. This fascia is very similar to that of the eardrum itself.

During the surgery, the eardrum is lifted up like a trap door. The doctor then slips the repair material (called a tympanic membrane graft) behind the eardrum. Then the eardrum is put back, and the doctor patches the hole from behind. The packing material that supports the graft dissolves over the next two to three months. During this time, the eardrum heals over the graft and resumes a normal appearance. When the packing is dissolved, hearing is restored to normal.

Sometimes a doctor can perform a tympanoplasty completely through the ear canal without making a large incision in the back of the ear. However, many children have small ear canals that are difficult to work through. Or, sometimes the hole is very large and cannot be completely seen through the ear canal. In these cases, a larger incision is made behind the ear to increase the working space.

Although a larger incision involves more healing and recovery, it considerably improves the operation's success in these more difficult cases. Best of all, when completely healed, the scar is difficult to see and is hidden from view by the outer ear.

Are there any instructions I should follow before surgery?

Your child must have a physical examination by his or her pediatrician or family doctor within seven days before surgery to make sure he or she is in good health. The doctor you see must complete the History and Physical form our office provides. You must bring the completed form with you the day of surgery.

For your child's safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines, or we will have to cancel your child's surgery.

What can I expect after surgery?

A patch myringoplasty usually takes 10 to 15 minutes. A tympanoplasty can take one to two hours. Your doctor will talk to you as soon as the surgery is over. Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour.

After waking, your child will be taken to the Short Stay post-operative area to complete the recovery. You may join your child at this time.

Children can almost always go home the same day of surgery. In rare cases, such as excessive nausea or vomiting, an overnight stay may be necessary. If your child stays overnight, one parent is also required to stay.

Bloody discharge or drainage from the ear canal for a few days after surgery are normal. Ear pain and soreness are also common after surgery. These symptoms should go away during the first three to five days after the procedure. Your doctor may prescribe pain medicine for the first few days.

How should I take care of my child after surgery?

Keep the ear canal clean and dry until you see your doctor (usually three weeks after surgery). During normal activities, keep a clean cotton ball in the ear canal. Change the cotton as often as needed. You will probably need to change it quite often during the first few days if the ear has bleeding or other drainage.

During baths or showers, coat a cotton ball with ointment (bacitracin, Vaseline, or triple antibiotic ointment) and place it in the ear canal. The ointment will prevent water from seeping in. After bathing, replace the cotton with a fresh, clean, dry cotton ball.

If your child had a postauricular tympanoplasty, the ear was likely bandaged with a gauze dressing and a Velcro strap. You may remove the strap and gauze the day after surgery. Keep the back of the ear dry for three days. You can then get the back of the ear wet. Pat the area dry after showers or baths. Do not rub. If there are little tapes on the skin (Steri-Strips) let them fall off on their own. They may even stay in place until you see your doctor for follow-up.

In most cases, your child may return to regular activities within one or two days. There is no need to restrict regular activity after your child feels normal. Vigorous exercise (such as swimming and running) should be avoided until you see your doctor (usually three weeks).

If your child complains of pain in the ear you can safely give Tylenol, Children's Motrin, or other pain medicine prescribed by your doctor. If you are not sure what medicines are safe,  call your doctor.

What else do I need to know?

  • Dizziness or persistent vomiting are uncommon after eardrum surgery. Please call our office if your child continues to vomit more than 24 hours after surgery or is having difficulty standing or walking.
  • Your child should not go swimming or travel by air until your doctor specifically tells you that is okay to do so.
  • Following a tympanoplasty, your child will not be able to hear normally in the operated ear until the packing behind the eardrum dissolves. This can take two to three months. The hearing will probably be worse than it was before surgery until this packing dissolves.
  • At the first postoperative visit, your doctor may gently clean the ear canal with a vacuum in order to inspect the reconstructed eardrum. You may be asked to use some antibiotic ear drops for a week or two to treat any postoperative inflammation.
  • A second hearing test will be done in eight to 12 weeks.

Last Edited: February 24, 2017
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