What is tympanoplasty?
The eardrum is a thin membrane between the ear canal and the middle ear. When sound reaches it, it vibrates. The vibrations pass to three tiny bones called the ossicles: the malleus, incus and stapes. Together they form the ossicular chain, which carries sound to the inner ear.
Tympanoplasty is the operation that repairs the eardrum and, if necessary, the ossicular chain. When only the eardrum is repaired, the procedure is called myringoplasty. The aim is to close the perforation and protect the middle ear from water and infection. Where possible, it also seeks to improve the passage of sound.
Perforated eardrum and chronic otitis media: when is surgery needed?
An eardrum perforation can be caused by infection, injury or ventilation tubes (grommets) placed in the past. Many recent perforations close on their own. If they stay open for months, the middle ear remains exposed to water and germs.
Chronic otitis media is a long-lasting inflammation of the middle ear. It often causes recurrent discharge from the ear, known as otorrhoea, and reduced hearing. If you notice these symptoms, a consultation is worthwhile. Only an examination of the ear can show the cause.
Tympanoplasty is generally considered in cases of:
- an eardrum perforation that does not close on its own;
- recurrent ear infections with discharge, often after contact with water;
- conductive hearing loss, meaning reduced hearing caused by an obstacle to the passage of sound;
- damage to the ossicles caused by past infections.
How do you prepare? The consultation and tests before surgery
Everything starts with an ENT consultation. The eardrum is examined with an otomicroscope or a small endoscope, instruments that magnify the view. A hearing test (audiometry) then measures how well you hear.
In some cases a CT scan is needed, an imaging test that shows the inside of the bone. As a rule, it is better to operate when the ear is dry and free from infection. Routine tests for the anaesthetic are also carried out before surgery.
The consultation also helps to identify a possible cholesteatoma. This is a particular form of chronic ear disease, in which skin grows inside the middle ear. If present, it needs specific assessment and treatment.
Consultations take place at the practice in Via Niccolò dall'Arca 19, Bari, near Bari Centrale station. Appointments can be booked online on MioDottore or by phone on 080 5219334.
How is tympanoplasty performed?
The operation is performed with an operating microscope, which allows precise work on structures just a few millimetres in size. The surgeon reaches the eardrum through the ear canal or through a small incision behind the ear. The choice depends on the position and size of the hole.
To close the hole, a graft is usually used: a thin piece of the patient's own tissue. It may be the fascia of the temporalis muscle, above the ear, or cartilage from the tragus, the small projection in front of the ear canal. The eardrum grows back on this base.
If the ossicles are also damaged, they can be rebuilt or replaced with a small prosthesis. This step is called ossiculoplasty. At the end, the ear canal is filled with a dressing, often absorbable, which holds the graft in place.
What anaesthesia is used and how long is the hospital stay?
Tympanoplasty is usually performed under general anaesthesia. The operation generally takes one to three hours. This depends on how extensive the repair is.
The hospital stay is usually short. You often go home the same day (day surgery), or stay one night. Pain is generally moderate and controlled with common painkillers. Dr De Candia gives personalised advice after the consultation, based on the planned operation.
What is recovery like after tympanoplasty?
In the first few weeks your hearing may feel muffled. This is normal: the ear canal is filled with the dressing. The doctor checks and removes it at follow-up appointments.
People with desk jobs usually return to work after 1–2 weeks. Manual work and sport may need longer. Hearing is reassessed with a new hearing test once healing is complete, generally after a few months. These timescales are a guide and vary from person to person.
To protect the graft, during the first few weeks you will generally be advised to:
- keep the ear dry in the shower and when washing your hair;
- avoid swimming pools and the sea until the doctor gives the go-ahead;
- avoid blowing your nose hard, and sneeze with your mouth open, so as not to build up pressure in the ear;
- avoid flying and diving;
- avoid strenuous effort and heavy lifting;
- attend all scheduled check-ups.
What are the risks of tympanoplasty?
Like any surgical procedure, tympanoplasty carries possible risks and complications. They are generally uncommon. They are explained in detail at the pre-operative consultation, together with informed consent. The main ones include:
- infection or bleeding;
- the eardrum not healing, or a new perforation forming over time;
- hearing not improving or, less commonly, getting worse;
- tinnitus (ringing or buzzing) and dizziness, usually temporary;
- altered taste on one side of the tongue, often temporary, due to a small nerve that crosses the middle ear;
- very rarely, injury to the facial nerve, which moves the muscles of the face.
Why choose an ENT specialist for tympanoplasty in Bari?
Ear surgery requires specific training and familiarity with the operating microscope. Dr Nicola De Candia has been a specialist in Otorhinolaryngology since 1991. He holds a PhD in the Pathophysiology of Audio-Verbal Communication from the University of Naples Federico II. This field studies hearing, speech and their disorders.
In 1993 he took part in the “Visiting Physician's program” at the House Ear Institute in Los Angeles, a US centre for research into the ear and hearing. He is also a specialist in Neurosurgery. Over his career he has performed more than 1,000 operations in total.
Every decision is made after the consultation. The expected benefits, limitations and alternatives are weighed up together with the patient.
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.