Section 12

What is the diagnosis?

  • Tympanic membrane perforation

Describe two symptoms.

  • Otorrhoea
  • Conductive hearing loss

What operation can be used to treat this condition?

  • Type 1 Tympanoplasty (Myringoplasty)

Name 3 potential autografts that can be used.

  • Temporalis fascia
  • Cartilage – tragal, conchal bowl
  • Subcutaneous fat


Describe 4 potential complications of the procedure.

  • Failure 
  • Abnormal sense of taste 
  • Vertigo
  • Hearing loss
  • Facial paralysis
  • Reaction to dressing

Supporting Information

Tympanic membrane perforation – normally by direct or indirect trauma. Symptoms include:

  • Pain
  • Deafness
  • Occasionally dizziness or vertigo

Perforations can be central/marginal, wet/dry. Acutely we want a dry ear. 

Acute perforations should be treated with prophylactic antibiotics if due to direct trauma. Otherwise no intervention is indicated other than re-inspection if hearing does not return to normal. Most heal themselves. If it has not healed and hearing loss persists, the patient may need a myringoplasty. 


  • Tympanoplasty – operation to eradicate disease from the middle ear and reconstruct the hearing mechanism where necessary including reconstruction of the tympanic membrane. 
  • Myringoplasty – reconstruction of the tympanic membrane alone

Detail – 

  • 5 techniques – the application of the new membrane onto the exposed middle ear bones. Described by Willstein and depend on the degree of bony destruction. 
  • Garcia-Ibanez added a 6th
  • Ossicles may be reconstructed using a bone autograft or ceramic malleus, incus and incudostapedial joint. 
  • Tympanic membrane repaired using autograft material- temporal fascia, fat, cartilage from the ear via endaural/postaural incision
  • After tympanoplasty the ear is dressed. This is removed after 1-2 weeks. Exertion/flying is avoided for 2 months. SCUBA diving is contraindicated and may displace prosthesis. 
  • 15% failure rate – higher in children, large perforations, in presence of infection
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