Tympanic membrane perforation: surgery and healing time

What to do? Treatment of tympanic membrane perforation

Medication for ruptured
tympanic membrane The doctor prescribes:

• medications for pain relief,
• Antibiotics (amoxicillin) in the form of tablets.

In the case of ruptured eardrums, antibiotic treatment serves to prevent a possible bacterial infection of the middle ear.
Doctors advise against the use of ear drops, as they can slow down the scarring process.

When to operate on eardrum perforation?

The decision to operate on an eardrum perforation (myringoplasty) is not easy for the following reasons:

1. The surgeon prefers to wait as long as possible, as recurrent infections and thus recurrences can occur.
2. Parents and children with injured eardrums want the operation to be done as soon as possible so that they can again bathe in the sea and swim in the swimming pool without risk. As long as the eardrum is perforated, the ear must not get wet to prevent infections.

There is one complication that requires immediate surgical intervention: acute mastoiditis; this is an infection in the mastoid process of the temporal bone with abscess formation.
In some cases, mastoiditis is less severe and can become chronic, so the infection recurs frequently.

Another complication is cholesteatoma, also in this case you have to act quite quickly, although not with absolute urgency.
The problem with cholesteatoma is the high rate of relapse (about 30% of cases). For this reason, the surgeon performs the procedure in two partial surgeries with an interval of 7-8 months.

1. The first procedure provides for surgical otomastoid cleaning.
2. In the second procedure, the healthy tissue is also reconstructed, so the success rate is very high.

Thanks to the double procedure, it is possible to see if the cholesteatoma has returned. If there is no cholesteatoma, only one procedure is performed.
Nowadays, myringoplasty is also performed on children aged 6-8 years.

Surgical intervention for tympanic membrane perforation

The operation of myringoplasty is performed:

• under general anesthesia in children and adolescents up to 16 years of age,
• with local anesthesia in adults.

The operation takes about one to two hours; if the surgeon gains access through the ear canal, the procedure is of shorter duration.

Surgery to restore the eardrum (myringoplasty)
This microsurgical procedure is performed with a microscope and endoscope in order to gain insight into the dark corners.

• The doctor numbs the patient or the ear area.
• As a rule, the surgeon makes an incision behind the ear to make it easier to get to the eardrum, but he can also access it through the ear canal.
• The doctor takes a small piece of tissue from the fascia (outer shell) of the temporal muscle to repair the eardrum. This is called a graft. Alternatively, a piece of the cartilage mass of the tragus (in the auricle) can be used.
  The removed tissue is positioned on a slide and dried.
• In order to get into the middle ear, an opening (flap) in the periosteum (periosteum) must be made.
• After that, the surgeon positions the implant and inserts a special sponge, which consists mainly of fibrin, to attach it.
• After the operation, medication is carried out inside the ear canal, which is covered with a cotton bandage.
• Finally, the doctor sews the incision behind the ear and applies a bandage.

The medications must be renewed every 24-48 hours. After surgery, the doctor may order antibiotics to avoid the risk of infection.

If the ossicle chain is also injured, the surgeon can use materials made of titanium or hydroxyapatite for restoration, in this case the procedure is called tympanoplasty.

Recovery time after surgery for eardrum perforation

After the procedure, the patient remains in the hospital for a few hours or a day.
If the surgeon has sutured the wound, you have to wait until the stitches are removed (about a week after the operation) before the hair can be washed.

As a rule, you can return to school or work after a few days.
In the weeks following surgery, the following symptoms may occur:

• discomfort when chewing,
• hearing loss,
• Noise in the ear.

As a rule, the patient does not feel any pain, only mild discomfort the day after the procedure.

Prevention of tympanic membrane perforation and precautions

• During air travel, you can protect your ears by using earplugs that compensate for the pressure, or chewing gum during take-off and landing. If there is a cold or nasal congestion, the flight should be avoided.
• Protect ears from strong noise. For this you can use earplugs or earmuffs. Lower the volume of music and TV. Permanent use of headphones should be avoided.
  Do not attend concerts and discos.
• Avoid water in the ear. If the eardrum is perforated or healing, you should avoid water getting inside the ear.
• Avoid soap and shampoo in the ear. When showering, wear a shower cap over your ears or carefully place a cotton ball in your ear.
• Do not jump into the water or dive.
• When swimming, use earplugs while the eardrum is still healing. Alternatively, a swim in the sea or swimming pool with a cotton ball soaked in petroleum jelly can be done.
• One can put a warm towel or a warm pack on the ear to relieve pain and discomfort.
• Do not clean the ears until the doctor allows. This is very important because you could cause damage during the healing process.

Is it safe to fly with a perforated eardrum?

Yes, it is safe to fly with an eardrum perforation. However, after a reconstruction of the perforated eardrum (myringoplasty), one should not fly until the doctor or surgeon allows it.

• When an aircraft takes off, the pressure in the interior drops. This means that there is a higher pressure in the middle ear than in the interior of the aircraft. As a rule, this is not a problem (whether the eardrum is perforated or not), because the air is pushed under the Eustachian tube and the pressure is balanced.
• When an airplane lands, the air pressure in the middle ear is below the pressure in the airplane and the Eustachian tube can close, triggering the feeling of blocked ears.

Low pressure in the middle ear can cause inward pressure of the eardrum, which may be uncomfortable and lead to temporary hearing loss.
After a short time, however, the situation returns to normality on its own.
If there is a perforation (hole) in the eardrum, the air should be able to move freely inside and outside the middle ear, because it does not need the Eustachian tube to enter and exit. Therefore, one should not have too much complaints.

If you go into the mountains, the different air pressure should not cause any damage, but you should chew gum and climb slowly.

Healing times for eardrum perforation (prognosis)

The time of recovery for spontaneous healing of the lesion is about 2-3 months even without therapy.
If the doctor prescribes therapy, it only serves to relieve the pain or cure an infection.
In some cases, surgical intervention must solve the problem.

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