Introduction
Tympanoplasty is a surgical procedure performed to reconstruct or repair a perforated (torn) eardrum (tympanic membrane) and, in some cases, the small bones of the middle ear (ossicles). The eardrum separates the outer ear canal from the middle ear and vibrates in response to sound waves. A hole in the eardrum can be caused by chronic middle ear infections, trauma (such as inserting a cotton swab too deeply), sudden loud noises, or barotrauma (rapid changes in air pressure). A perforated eardrum can lead to hearing loss, recurrent ear infections, and a persistent discharge from the ear. Tympanoplasty aims to close the perforation, prevent water and bacteria from entering the middle ear, and improve or restore hearing.

Surgical Procedure
The surgery is usually performed under general anesthesia, though local anesthesia with sedation can be used for adults. The procedure typically takes 1 to 2 hours.
Depending on the size and location of the perforation, the surgeon will access the eardrum either directly through the ear canal (transcanal approach) or by making an incision behind the ear (post-auricular approach).
To repair the hole, the surgeon uses a graft. The graft material is most commonly taken from the patient’s own body, typically the fascia (connective tissue) covering the muscle behind the ear or cartilage from the tragus (the small bump in front of the ear canal).
The surgeon carefully lifts the remnants of the eardrum and places the graft underneath or over the hole. Dissolvable packing material (like Gelfoam) is placed in the middle ear and the ear canal to hold the graft securely in position while it heals. If the small bones of the middle ear are also damaged, the surgeon will repair or reconstruct them during the same procedure (ossiculoplasty). The incision behind the ear, if made, is closed with stitches.

Surgical Risks
Tympanoplasty is generally a safe and successful procedure, but it involves operating in a delicate area near important nerves and structures. Standard surgical risks, including reactions to anesthesia and bleeding, apply.

General Complications
Common post-operative symptoms include:
– Mild ear pain or a dull ache for a few days.
– A feeling of fullness, pressure, or liquid in the ear, largely due to the packing material.
– Bloody or watery discharge from the ear canal for a week or two.
– Temporary worsening of hearing due to swelling and packing in the ear canal.
– Mild dizziness or imbalance for a few days.

Rare but Serious Complications
Severe complications are rare but can include:
– Graft failure: The graft may not take, and the hole in the eardrum remains, requiring a second surgery.
– Hearing loss: In rare cases, hearing may worsen or be completely lost in the operated ear.
– Tinnitus: Ringing or buzzing in the ear that may be new or worsened.
– Facial nerve injury: The nerve that controls facial muscles runs near the middle ear. Injury can cause temporary or, very rarely, permanent weakness or paralysis on one side of the face.
– Altered taste: A nerve controlling taste on the side of the tongue passes through the middle ear and can be stretched or cut, leading to a metallic taste or loss of taste, which is usually temporary.

Pre-operative Preparation
– Medical Evaluation: A thorough ear examination using a microscope and a hearing test (audiogram) to establish a baseline.
– Infection Control: The ear must be free of active infection before surgery. Your doctor may prescribe antibiotic ear drops for several weeks prior.
– Fasting: If general anesthesia is used, you must fast for 8 to 12 hours before the procedure.

Post-operative Care
Most patients go home the same day. You will have a bandage over your ear. Pain is usually manageable with over-the-counter pain relievers or prescribed medication.

Wound Care
– Keep the ear completely dry. When showering, place a cotton ball coated with petroleum jelly (Vaseline) in the outer ear to prevent water from entering.
– Do not remove the packing in your ear canal; it will dissolve on its own or be removed by your doctor.
– If you have an incision behind the ear, keep it clean and dry according to your doctor’s instructions.

Diet
You can resume a normal diet, but avoid chewing hard or chewy foods for the first few days, as the jaw joint is very close to the ear canal and vigorous chewing can cause pain.

Post-discharge Notes
Full healing of the eardrum takes several weeks.
– Do not blow your nose. If you must sneeze, do so with your mouth open to avoid putting pressure on the healing eardrum.
– Avoid flying, scuba diving, or any activities involving rapid altitude changes for at least a month, or until cleared by your doctor.
– Avoid strenuous exercise and heavy lifting for a few weeks.
– Contact your doctor if you experience severe dizziness, a sudden loss of hearing, severe pain, or a foul-smelling discharge from the ear, as these may indicate an infection or graft issue.