Myringoplasty - Explained By Dr. Rajesh Bhardwaj #entsurgeon #entspecialist #entdoctor


Myringoplasty -

Perforation of the ear drum can occur due to trauma or infection.

Middle ear infection (Otitis Media) quite often leads to a perforated ear drum.

A perforated ear drum causes hearing loss and is an open access for infections to travel to the middle ear from the external ear.

Frequent colds, ingress of water in the ear are two of the commonest causes for discharge from the ear.

Every time there is discharge from the ear the toxins released by the bacteria can enter the inner ear through permeable membranes and cause a sensorineural hearing loss which is a permanent kind of hearing loss.

It is therefore advised that a persistent perforation of the ear drum must be repaired surgically – a procedure called Myringoplasty (Myringo-eardrum, Plasty- repair).


Approaches for Myringoplasty

  • Per Meatal – for very small perforations, wide ear canal, or if done Endoscopically
  • Post Aural – the most common approach- from behind the ear – in the groove where the pinna is attached.
  • Endaural- For posterior perforations or if associated with a mastoidectomy.

Graft Material used for Myringoplasty
  • Paper patch, Fat – for pin hole perforations – very uncertain results
  • Temporalis Fascia – Dense membrane above the ear – probably the most commonly used tissue for eardrum repair
  • Tragal Perichondrium- from the Tragus (cartilage in front of the ear).
  • Composite graft – combined cartilage and Tragal perichondrium – specially in case of retraction pockets or where the eardrum is being pulled in on account of negative pressure.

Myringoplasty Procedure

In a typical Myringoplasty done by the post aural approach –

Hair around the operated ear is shaved for access and for dressing purposes
The operated part is cleaned and sterilized with Povidone Iodine
2 % Xylocaine with adrenaline is infiltrated
A skin incision is made in the groove behind the er and skin flaps lifted
Temporalis Fascia graft is harvested
Edges of the perforation are freshened
Tympanomeatal flap is elevated
Graft is placed in the ear over self absorbing gelatin sponge in the middle ear
Ear pack is applied
Wound is closed – usually subcuticular sutures are applied
Mastoid bandage is applied

Post Operative Period

The mastoid bandage is usually removed on day 5
Aural pack is removed 10-14 days later
Neomembrane formation typically takes about 4-6 weeks
Care during Post Op period
Ear must be kept dry
Treat a cold immediately
Avoid air travel for about 3-4 weeks
Inform doctor immediately in case of Facial weakness/ Paralysis including incomplete eye closure, giddiness, Tinnitus (buzzing in ears), Nausea / Vomiting
Do not blow your nose vigorously

Anaesthesia for Myringoplasty

Local Anaesthesia – Injection of Local Anaesthetic into the ear and surrounding tissues.
MAC – Monitored Anaesthesia care – Patient is not intubated, the Anaesthetist gives sedation and pain medication via an Intra Venous route.
General Anaesthesia – full GA.
The decision is taken depending upon the patient’s and the surgeon’s preference as well as on other medical factors.

Complication of Myringoplasty

Though generally safe and well tolerated there are some complications of the procedure- –

Graft rejection
Residual perforation
Facial nerve damage
Hearing loss
Tinnitus
Giddiness etc

Myringoplasty with Insurance & health policy - MedFirst
MedFirst ENT Centre is dedicated to providing a seamless experience for patients seeking ENT-related medical care, with affiliations with major insurance companies to facilitate the financial aspects of treatment, including myringoplasty. Their exceptional Third Party Administrator (TPA) team ensures an efficient and stress-free health claim process, whether for Group Health Insurance Plans, Individual/Family Health Insurance Plans, or procedures like myringoplasty. This commitment to streamlining insurance-related processes underscores their dedication to patient care and convenience.

Understanding how health insurance policies and TPAs can assist in covering myringoplasty costs is vital when considering this surgical procedure to correct a deviated nasal septum. MedFirst advises proactive measures, including a comprehensive insurance policy review and choosing an ENT clinic within the insurance network that specializes in myringoplasty. Collaboration with the TPA streamlines claims processing, providing a confident and cost-effective myringoplasty experience, ensuring patients can breathe easier, both physically and financially.

There is no other cure for a persistent perforation of the ear drum- it can only be repaired surgically.

#Myringoplasty #EarHealth #ENTProcedure #PerforatedEardrum #ChronicEarConditions #ENTCare #SurgicalRepair #HearingRestoration #EarInfectionPrevention #HealthAwareness #ENTSpecialist #SurgicalApproaches #GraftMaterials #PostoperativeCare #AnaesthesiaOptions #ComplicationsAwareness #InsuranceCoverage #HealthPolicy #TPAAssistance #PatientCare

Location: Vasant Vihar, New Delhi, Delhi, India

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