The tympanic membrane, commonly known as the eardrum, is a thin membrane that separates the outer ear from the middle ear. Sound waves strike it and cause it to vibrate, which plays a crucial role in transmitting sound to the inner ear and from there to the brain. In some cases, such as after a trauma or repeated ear infections (otitis), a hole may form in the eardrum. In most cases, this hole heals and closes on its own. However, if this does not happen within a few weeks, the perforation is considered permanent. The patient typically experiences otorrhea, which is the discharge of fluid (pus and/or blood) from the ear, pain, and hearing loss. Additionally, during showers or when swimming in the sea or a pool, the ear must be constantly protected from water. The solution is tympanoplasty, a surgical procedure that closes the hole in the eardrum and restores the issues it causes.
The surgery is usually performed under general anesthesia with a small incision either behind the ear (postauricular approach) or within the external auditory canal (endaural approach). Smaller perforations can be repaired with local anesthesia and a canal-based approach. To close the hole, we typically use temporal fascia, a membrane covering the temporalis muscle, which is taken through the same incision made for the tympanoplasty. For larger perforations, a piece of cartilage may be used, which is taken from the ear’s tragus in such a way that no aesthetic impact occurs. The graft is placed with a special technique in the perforated area and secured with a fine gauze to integrate during the healing process and form the new eardrum. The incision is closed with absorbable sutures. At the end of the procedure, a special bandage is placed around the head, which remains for 24 hours.