Myringoplasty (Type 1 Tympanoplasty)

Indications

Repair of a tympanic membrane perforation that is causing repeated or chronic discharge (mucosal chronic otitis media). 

Repair of a perforation to allow normal activities such as swimming.

NB Myringoplasty is synonymous with “type 1 tympanoplasty”. It is not performed primarily to treat associated conductive hearing loss, as the hearing results are unpredictable.

Procedure

Perforations are generally repaired by placing a graft composed of fascia, cartilage or perichondrium on the underside (medial side) of the perforation. The medial side is accessed by raising the tympanic membrane up with a cuff of ear canal mucosa attached (a tympanomeatal flap). The perforation can accessed down the ear canal (permeatal), by enlarging the canal via an endaural incision, or via a postauricular incision. The approach used depends on the site of the perforation and the surgeon’s preference. 

Length of procedure

Around one hour if uncomplicated.

Complications

Pain

Bleeding (rare)

Infection Also quite rare.  If BIPP (a bright yellow antiseptic) ribbon is used, this sometimes causes a yellow-brown discharge which can be mistaken for infection.

Graft failure / recurrence It is important to explain to patients that even in a correctly-performed myringoplasty, there is a reasonable chance of the perforation recurring (up to 20%).  This may indicate revision myringoplasty.

Hearing loss  Uncommon but may occur due to stress on the ossicular change.

Facial palsy Extremely rare in myringoplasty, but should be mentioned.

Taste disturbance The chorda tympani runs across superior tympanic membrane, and should be identified and preserved.  Damage can lead to a metallic taste, although this usually improves over time.

Tinnitus Usually temporary, but rarely long-lasting.

Dizziness Again, usually a temporary postoperative effect.

Reaction to BIPP packing A rare allergic-type reaction to BIPP packing (if used); the patient will have previously been sensitised by similar packing. The pinna and surrounding soft tissues will become hot and red quite soon ie within 24-36 hours of the operation, as distinct from a post-operative cellulitis.

Scar (if endaural/postauricular approach used).

Post-operative management

The patient goes home the same day. The ear canal dressing is removed in clinic two weeks later. 

TTO

Simple analgesia. Occasionally ear drops are prescribed – check the op note.

 Page last reviewed: 4 January 2023