Myringoplasty is the closure of the perforation of pars tensa of the

tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air ...

. When myringoplasty is combined with removal of scar tissue, it is called

tympanoplasty Tympanoplasty is the surgical operation performed to reconstruct hearing mechanism of middle ear Classification Tympanoplasty is classified into five different types, originally described by Horst Ludwig Wullstein (1906–1987) in 1956. # Type ...

. The operation is performed with the patient supine and face turned to one side. The graft material most commonly used for the surgery is temporalis fascia. The tragal cartilage and tragal perichondrium are also used as the graft by some surgeons. Myringoplasty restores hearing loss in certain cases of

tinnitus Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...

. The chances of re-infection and persistent discharge is less after surgery. Myringoplasty should not be performed if there is active discharge from the middle ear, or if the patient has uncontrolled nasal allergy, or when the other ear is dead and in children less than 3 years of age. Myringoplasty is often done under general anaesthesia, but it can be done under local anaesthesia also.

Technique of surgery

Underlay technique

The

temporalis fascia The temporal fascia covers the temporalis muscle. It is a strong, fibrous investment, covered, laterally, by the auricularis anterior and superior, by the galea aponeurotica, and by part of the orbicularis oculi. The superficial temporal vessels ...

is grafted. An incision is made along the edge of the perforation and a ring of epithelium is removed. A strip of mucosal layer is removed from the inner side of the perforation. The middle ear is packed with

gelfoam Embolization refers to the passage and lodging of an embolus within the bloodstream. It may be of natural origin (pathological), in which sense it is also called embolism, for example a pulmonary embolism; or it may be artificially induced ( ...

soaked with an

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

. The edges of the graft should extend under the margins of the perforation and a small part should also extend over the posterior canal wall. The tympanomeatal flap is then replaced.

Overlay technique

The temporal fascia is harvested. An incision is made to raise medial meatal skin with

epithelium. The graft is placed on the outer surface of the tympanic membrane and a slit is made to tuck it under the handle of

malleus The malleus, or hammer, is a hammer-shaped small bone or ossicle of the middle ear. It connects with the incus, and is attached to the inner surface of the eardrum. The word is Latin for 'hammer' or 'mallet'. It transmits the sound vibrations fro ...

. The ear is packed with gelfoam and antibiotics, and the incision is closed. Finally

mastoid dressing The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has openings for blood vessels. From its borders, t ...

is performed.

Advantages

* Restores the hearing loss and in some cases,

. * Checks the re-infection from external auditory canal and

eustachian tube In anatomy, the Eustachian tube, also known as the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in d ...

. * Checks aeroallergens reaching the exposed middle ear mucosa, leading to persistent ear discharge.

Contraindications

* Active discharge from the middle ear * Nasal allergy, which should be controlled before surgery * When the other ear is dead or not suitable for hearing *

Otitis externa Otitis externa, also called swimmer's ear, is inflammation of the ear canal. It often presents with ear pain, swelling of the ear canal, and occasionally decreased hearing. Typically there is pain with movement of the outer ear. A high fever is ...

* Children below 3 years

References