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Last updated May 4, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Jack M. Kartush, MD

Over-Under tympanoplasty places a fascia graft over the malleus and under the remaining ear drum.

Background Information:

What are the other Names for the Procedure?

  • Eardrum Repair
  • Myringoplasty
  • Tympanosclerosis Treatment

What is Tympanoplasty surgical procedure?

  • Tympanoplasty is a microscopic procedure that involves the removal, repair, or bypass, of an obstruction or defect in the middle ear
  • It is generally used to repair the eardrum (also called tympanic membrane), and hence known as Eardrum Repair procedure

What part of the Body does the Procedure involve?

A Tympanoplasty procedure involves the eardrum (tympanic membrane), the middle ear cavity and its contents.

Why is the Tympanoplasty surgical procedure Performed?

The Tympanoplasty procedure is performed to restore or improve hearing.

What are some Alternative Choices for the Procedure?

Myringoplasty is another operative procedure used in the reconstruction of the eardrum; however, it can only be carried out for small perforations.

What are the Recent Advances in the Procedure?

Tympanoplasty has remained as the gold standard procedure for the conditions mentioned above.

What is the Cost of performing the Tympanoplasty surgical procedure?

The cost of Tympanoplasty (Eardrum Repair) procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Tympanoplasty procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/003014.htm (accessed on 08/03/2014)

http://www.surgeryencyclopedia.com/St-Wr/Tympanoplasty.html#b (accessed on 08/03/2014)

Prior to Tympanoplasty surgical procedure:

How is the Tympanoplasty surgical procedure Performed?

The Tympanoplasty procedure is performed as follows:

  • Anesthesia is administered to the patient, after which an instrument, called the ear speculum, is placed in the external ear canal and the operating microscope is positioned
  • An incision is made into the ear canal; the eardrum is elevated from the canal and lifted forward
  • If the perforations are large, then an incision is made behind the ear giving easy access to the perforation. Once the hole is fully exposed, the hole(s) and the bones are inspected
  • If scar tissue is present, it is removed either with micro hooks or laser. The graft is then inserted underneath the remaining eardrum remnant, which is folded back onto the perforation to provide closure
  • If the incision is made behind, the ear is stitched together

Where is the Procedure Performed?

The Eardrum Repair (or Tympanoplasty) procedure is generally performed in the surgical facility of a hospital or an out-patient surgical facility at a clinic.

Who Performs the Procedure?

The Tympanoplasty procedure is performed by an Ear-Nose-Throat specialist (otorhinolaryngologist).

How long will the Procedure take?

The Tympanoplasty procedure takes about 2-3 hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Tympanoplasty procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Tympanoplasty surgical procedure?

The physician may recommend the following tests, before the Tympanoplasty procedure:

  • Audiogram and other hearing tests
  • Routine blood tests
  • Routine urine examination

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is the Tympanoplasty procedure?
  • Why is this procedure necessary?  
  • What does the procedure involve?
  • How will this procedure help?
  • Will I need adjunct treatments after the surgery? 
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place while recovering?
  • When can I resume normal work?
  • Are there any life style restrictions needed after the procedure is performed?
  • After recovering from the procedure, are there any follow-ups or tests? If yes, then how often?
  • Are there any life-long medications that need to be taken after the procedure?
  • How many procedures have you performed?

During the Tympanoplasty surgical procedure:

What kind of Anesthesia is given, during the Procedure?

A general anesthesia with an injection and inhalation, by placing a tube in the windpipe is generally administered, during the Tympanoplasty procedure.

How much Blood will you lose, during the Procedure?

The blood loss during the Tympanoplasty procedure is minimal, unless complications arise.

What are the possible Risks and Complications during Tympanoplasty surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Tympanoplasty surgery are:

  • Excessive bleeding
  • Damage to the facial nerve or nerve controlling the sense of taste
  • Damage to the small bones in the middle ear, causing hearing loss
  • Infection
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after Tympanoplasty surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Tympanoplasty surgical procedure:

What are the possible Risks and Complications after Tympanoplasty surgical procedure?

Post Tympanoplasty procedure, the following complications may arise:

  • Bleeding
  • Infections
  • Breathing problems
  • Reactions to medicines or anesthesia
  • Dizziness or vertigo
  • Incomplete healing of the hole in the eardrum
  • Worsening of hearing, or, in rare cases, a complete loss of hearing

What is the Prognosis after the Surgery?

In a majority of the cases, the pain and infection is relieved without any complications.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms after an Eardrum Repair (Tympanoplasty) procedure:

  • Infection
  • Pain, redness, or swelling
  • Fever, nausea or dizziness

What Post-Operative Care is needed at Home after Tympanoplasty surgical procedure?

At home, the following post-operative care is recommended, after a Tympanoplasty procedure:

  • No water should enter the ear till the doctor advices
  • No vigorous exercises for the first few weeks
  • Avoid air travel
  • Apply the ear drops regularly, as prescribed by the doctor
  • Take the antibiotics prescribed by the doctor regularly
  • Avoid catching a cold

How long does it normally take to fully recover, from the Procedure?

It would take about 4 weeks to fully recover from the Tympanoplasty procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Tympanoplasty surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility
  • Ear-nose-throat specialist
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist

Individuals are advised to inquire and confirm the type of billing, before the Tympanoplasty procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 19, 2014
Last updated: May 4, 2018