The eardrum is a structure which measures approximately 0.9 x 0.8 cm and separates the outer ear and the middle ear from each other, protecting the middle ear cavity from the external environment and helping us hear. Thinning and collapse of the membrane, especially after ear infections as a child, external blows to the eardrum or after barotraumas may cause ruptures in the membrane. Severe pain, bleeding, and decreased hearing are the findings in post-traumatic ruptures. In ruptures due to previous infections, the finding is hearing loss, occasional discharge and tinnitus.

The most important success criterion is the absence of discharge in the eardrum before the operation in eardrum ruptures. Ears that are dry and have no discharge, and ears with loss of conduction ability as a result of hearing tests constitute the candidate patient group for eardrum repair. In some patients, if the conductive loss is excessive, there may be rupture, calcification and melting of the ossicular system in the middle ear. The diagnosis of this can only be understood by seeing it with a microscope during the operation. While the membrane is repaired, the ossicles in the middle ear can also be intervened in the same session.

Contents

• What is a Ruptured Eardrum?
• How to Protect the Eardrum
• Why Does an Eardrum Get Perforated?
• How Do We Know If the Eardrum is Perforated?
• How is Eardrum Repair Surgery Performed?
• Are There Any Stitches Used in the Eardrum Surgery?
• How Soon Can I Take a Bath?
• How Soon Can I Hear?
• At What Ages is the Surgery Performed?
• Surgery Process
• Post-Surgery Life

What Is A Ruptured Eardrum?

The eardrum can rupture for many reasons. Primary reasons are infections and discharges. If the rupture is not repaired on time, hearing loss from simple to more advanced levels may occur. This makes eardrum repair surgery mandatory. Developing technology allows for more comfortable surgeries for these ruptures.

Ear discharge, which is not noticed since childhood, can cause the destruction or rupture of the eardrum after a while with the substances it contains. If these ruptures are small in size, they can sometimes heal on their own without being noticed. However, if this situation is not followed correctly in patients who cannot repair themselves, very serious hearing loss may occur. Especially in young children, object-caused eardrum rapture may also occur, hence the cause of the rupture should be investigated together with a detailed examination.

It is very important to determine the degree of hearing loss in the detailed examination. Some patients may experience losses at 20-30%. Although these minor-grade losses are uncomfortable for the patients, they may not require immediate intervention like advanced-grade losses. For this reason, a detailed examination should be made by the physician by evaluating many factors.

How to Protect the Eardrum?

People with complaints such as nasal congestion, sinusitis and post-nasal drip should avoid airplane travel and underwater diving. Those with a ruptured eardrum need to be more careful to protect the eardrum. First of all, water should not be leaked into the ear. For this, earplugs purchased from the pharmacy can be used. Ear cottons and ear cleaning sticks should not be used. The nose should not be cleaned by blowing in order to avoid the damage caused by the pressure.

Repair of eardrum rupture is possible with eardrum surgery. During eardrum surgery, the new membrane is formed using the muscle at the back of the ear in the person's own body. In other words, no artificial membranes are used in eardrum repair. The method in which the cartilage and membrane located in front of the external ear canal are used in combination does not leave any traces and is one of the most preferred methods in terms of retention and durability.

Why Is The Eardrum Perforated?

• Middle ear infection
• An example of barotrauma is the deterioration of the balance between the air pressure in the middle ear and the air pressure in the environment (air travel, scuba diving, etc.).
• Loud noise
• Foreign object pushed into ear
• Severe head injury

How Do We Know If the Eardrum is Perforated?

Ear pain, discharge from the ear, hearing loss, dizziness and high fever are among the main symptoms of eardrum perforation.

Perforation of the eardrum is diagnosed by the ENT physician as a result of looking at the ear with an instrument called an otoscope. The ENT physician can see the size and location of the hole with the otoscope.

How is an Eardrum Repair Surgery Performed?

Repair of the eardrum may vary depending on the size and cause of the rupture. If the hole in the eardrum is small, the hole can repair itself and close. In this case no treatment is required. 

In cases where the eardrum hole does not close on its own, eardrum surgery is applied. In these surgeries, artificial membranes are not used, a patch is made by removing the membrane from the muscle at the back of the ear or by making a membrane from the cartilage tissue in front of the external auditory canal. My most preferred method is the one in which the cartilage and membrane located in front of the external ear canal are used in combination, as it does not leave any traces, has the highest chance of retention, and is durable.

Are There Any Stitches Used in the Eardrum Surgery?

In membrane repair surgeries, where we intervene in the eardrum, the repair can be made by making an incision behind the ear, or it can be done by entering only through the hole in the external ear canal without cutting. I perform almost all of these surgeries through the ear. There is no incision or stitching behind the ear, and the patient can return to his daily life much more quickly.

How Soon Can I Take a Bath?

Three days after this surgery, the ear can be covered with a special waterproof gelatin and a bath can be taken.

How Soon Can I Hear?

Since there are sponges that can dissolve in the ear after the surgery, the ears will be clogged and it will take 20 days for these sponges to dissolve. Hearing improves 20 days after the operation, and the time for the patient to fully realize the improvement 2 months.

At What Ages is the Surgery Performed?

It can be started for the patient at the age of 12 when the hearing loss is at low levels, depending on the person's request. However, in the case of severe hearing loss, performing this surgery as soon as it is noticed for the first time, regardless of age group, will allow the hearing loss to be intervened without progressing any further. With new techniques, older people can also gain a healthy hearing sensation in these surgeries.

Surgery Process

Eardrum repair surgery is a procedure that should be decided for considering with many factors, and observing each stage well. The fact that it is performed with microsurgery methods allows only a small incision to be visible from the outside. Surgery can be initiated by opening incisions from the auricle or the back of the ear. This varies according to the structure of the ear and the degree of hearing loss, deformities in the membrane. In the tympanoplasty surgery performed with the cartilage method, the cartilage taken from these regions is made suitable for placement with the correct cutting methods.

In order for the ear to accept this cartilage as a membrane, it is very important to find the right cutting shape. Afterwards, placement is one of the most important stages. When placement is performed correctly, no problems occur in the later stages. Since it is a process that is performed with very small movements, it must be performed by competent persons. Otherwise the ear structure may not accept the tissue that is prepared as a membrane.

Post-Surgery Life

After the eardrum repair surgery, patients can continue their lives comfortably after 1 day. Hospital discharge process vary according to the existence of complications. For this reason, thorough physician observation is essential. It is very important to keep the surgery area clean with special drops and certain cleaning products. Preventing the area from getting moise is a key step in a good healing process. Therefore, the area should be kept away from water. If the surgery is only around the membrane, the healing process is much faster. However, if other places are also intervened, the process may take a little longer. Staying away from flu infections at first contributes to a good healing process.