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 be 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 chain.
  • Facial palsy: extremely rare in myringoplasty, but should be mentioned.
  • Taste disturbance: the chorda tympani runs across the 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: 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, i.e. 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: 30 July 2026