Myringoplasty

What is a myringoplasty?

A myringoplasty is an operation to repair a hole (perforation) In the eardrum (tympnnic membrane).

Your surgeon has recommended a myringoplasty. However, it is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to he?) you make an informed decision.

If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team.

How does a perforated eardrum happen?

A perforation is usually caused by an infection in the middle ear that bursts through the eardrum.

A perforation can be caused by inserting a grommet into the ear (risk: 1 in 100).

Often a perforated eardrum does not cause any problems but it can lead to repeated ear infections and poorer heaving.

What are the benefits of surgery?

Surgery can prevent repeated ear infections and sometimes improve hearing.

Are there any alternatives to surgery?

Keeping the ear dry by placing cotton wool and Vaseline in the ear when bathing or washing your hair may prevent infection. An infection can be. treated with antibiotics and a trained healthcare practitioner can clean the ear. A hearing aid can improve poor hearing but can also lead to more infections.

What will happen if l decide not to have the operation?

Ear infections may continue and your hearing will get worse with age (although not any faster than without a perforation).

Infection can spread either to the bone behind the ear, causing mastoiditis (risk: 7 in 10,000), or to the brain, causing meningitis or a brain abscess (risk: 1 in 10,000).

What does the operation involve?

A myringoplasty is usually performed under a general anaesthetic but a local anaesthetic can be used. Your anaesthetist will discuss the options with you and recommend the best form of anaesthesia for you. The operation usually takes between an hour and an hour and a half.

Your surgeon will need to use a graft (piece of tissue) to cover the hole. The most common material used is the covering layer of a muscle which is above the ear. Occasionally some cartilage is used from around the ear. This will not change the shape of the ear.

Your surgeon will insert the graft through a cut made either in horn of or behind your ear or inside your ear canal They will hit the eardrum and place the grail underneath it and support it with a dissolving sponge They will then put the eardrum back. A pack in the ear canal and a head bandage may be used. Your surgeon will discuss this with you.

What should I do about my medication?

You should continue your normal medication unless you are told otherwise. Let your surgeon know if you are on warfarin or clopidogrel Follow your surgeon’s advice about stopping this medication before the operation.

What can l do to help make the operation a success?

Lifestyle changes

if you smoke, ‘try to stop smoking now. Stopping smoking several weeks or more before an Operation may reduce your chances of getting complications and will improve your long-term health.

Exercise

Regular exercise can reduce the risk of heart disease and other medical conditions, improve how your lungs work, boost your immune system. help you to control your weight and improve your mood. Exercise should help to prepare you for the operation, help with your recovery and improve your long-term health.

For information on how exercise can help you go to www eidoactive.co.uk.

What complications can happen?

  • Lifestyle changes

The healthcare team will try to make your Operation as safe as possible However complications can happen. You should ask your doctor if there is anything you do not understand Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you .

The complications fall into three categories.

  •  Complications of anaesthesia
  •  General complications of any operation
  •  Specific complications of this operation

1. Complications of anaesthesia

Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

2. General complications of any operation

Pain, which happens with every operation. The healthcare team will try to reduce your pain. They will give you medication to control the pain and it is important that you take it as you are told.

Bleeding during or after surgery. This may cause some bruising around the ear. Rarely, a blood clot may develop under the skin and a further operation will be needed to remove it.

Unsightly scarring of the skin, although myringoplasty wounds usually heal neatly.

3. Specific complications of this operation

Failure of the graft (risk: 1 in 6 in the first six months).

Loss of hearing, which can be total and permanent. This ‘is rare.

Tinnitus (ringing in the ear), which is rare. it you already have tinnitus, it will probably stay the same but may get worse after the operation.

Change of taste, as the nerve responsible for taste passes just inside of the eardrum and may be stretched or damaged. Taste will usually return to normal after a few months.

infection, which results in a discharge from the ear and may also cause the graft to fail .

Allergic reaction to the pack material, which results in pain, swelling and discharge from the ear and may also cause the graft to fail. You should let your surgeon know if.you are allergic to iodine.

How soon will i recover?

ln hospital

After the operation you will be transferred to the recovery area and then to the ward. You may be able to go home the same day. if you do go home the same day, a responsible adult should take you home in a car or taxi, and stay with you for at least 24 hours.

if a head bandage has been used, it will be removed the morning after surgery and you should be able to go home that day. However, your doctor may recommend that you stay a little longer. ‘ If you are worried about anything, in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Your surgeon will tell you when you can return to normal activities. You should stay off work for two weeks. You will be able to fly without having a y problems with your ear.

Regular exercise should help you to return to normal activities as soon as possible Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive for at least 24 hours after the operation and not until you are confident about controlling your vehicle. Always check with your doctor and insurance company first.

The future

Most people make a good recovery. You will be seen in the outpatient clinic two to three weeks after the operation to remove the pack (if one has been inserted) and to check the graft. Sometimes ear drops are prescribed at this visit.

You should protect your ear from water, using cotton wool and Vaseline, until your surgeon is satisfied that the graft has worked. If the graft Is successful, you should not get ear infections and you will be able to swim and bathe as normal.

Summary

A perforated eardrum is a common problem. A myringoplasty can prevent infections and sometimes improve your hearing. Surgery is usually safe and effective.
 
However, complications can happen You need to know about them to help you make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

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