Eardrum Repair Surgery
Listed below is the step by step procedure of eardrum repair surgery:
- What is Eardrum Repair Surgery ?
- Why is Eardrum Repair Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Eardrum Repair Surgery
- Post Procedure
- Risks and Complications
What is Eardrum Repair Surgery ?
Operation done to treat damage to the eardrum comprises eardrum surgery. The aim of this surgery is to restore normal ear function by repairing or replacing the damaged tissue. Care has to be taken to avoid damage to adjacent healthy organs and tissue.
This surgery can be done by using patches to repair the damaged ear membrane. Sometimes the ear bones are damaged. They could need repair or replacement depending on the degree of damage.
Why is Eardrum Repair Surgery Required?
Eardrum is a membrane present between the middle ear and inner ear. The ear drum also known as tympanic membrane is connected to three bones viz., malleus, incus and stapes. These are connected in a series. Coordinated function of the membrane and three bones helps in conducting sound waves up to brain which eventually helps in hearing.
Damage to eardrum will affect the transmission of noise and lead to partial or total hearing loss. Eardrum damage can often be treated with medicines. Sometimes however, surgical intervention might be needed. Following are the indications for eardrum repair surgery:
- Eardrum Perforation: The eardrum is a thin membrane which is permissible to sound. Harsh impacts like insertion of sharp objects into the ear, exposure to deafening noises, recurrent exposure to noise of high decibels can damage the ear drum.
A perforation may develop which will not allow proper passage of sound waves. This will affect the person's hearing.
- Otitis Media: This is the medical terminology for ear infection. There could be resultant swelling and accumulation of fluid or pus in the ear. Antibiotics can control the condition. But sometimes they may not be able to curb the infection and eventually there could be damage to the ear drum.
- Altered Hearing Sensation: If the ear drum is damaged, the further conduction of sound is hampered. Sometimes if the damage is very less in intensity, the person may have negligible symptoms. But substantial damage or a perforation in the eardrum will result in reduction or complete loss of hearing.
- Other Symptoms: Ear pain, bleeding from the ear, constant buzzing in the ears, severe pain in the ear are some of the symptoms of internal ear problems. Progressive worsening or failure to resolve these symptoms could be due to damaged ear drum and may need surgical intervention.
If surgery is needed to treat eardrum perforation, the surgeon will plan the procedure in advance. Some pre-operative steps are given below which are expected to be followed before the actual surgery:
- Interaction With Patient: Eardrum surgeries are not extremely complex and hence tend to have a predictable outcome. Still it is essential to discuss about the procedure with patients before surgery. Eardrum surgeries are performed by an ENT surgeon. The procedure of surgery will be explained to the patient. Pre-surgery and post-surgery care instructions, risks and complications of the procedure are discussed with the patient. Consent is taken from patient before the surgery.
- Investigations: A blood test is done prior to ear drum repair surgery. White blood cell count is done to rule out existing infection. If it is present, antibiotic therapy is given. Infections have to be curbed before surgery. Tests are done to rule out elevated blood sugar. In such cases, surgery is postponed till blood sugar levels return to normal.
- Ear Care: An infected ear tends to remain wet often as there is pus formation. The patient has to keep the ear as dry as possible for a month before surgery. In case of fungal infection of the ear, creams or powder for local application may be prescribed to the patient.
Day Before Surgery
Surgery for eardrum may be done without admitting the patient to hospital if the area of damage is not extensive. The patient needs to visit the hospital only for the surgery and may leave soon. In that case, the patient needs to take care of their ear at home itself. If the eardrum is extensively damaged, the surgery may be done under general anesthesia. The person might be asked to be admitted into the hospital a day prior to surgery. Blood pressure, pulse, breathing rate, body temperature are noted.
If surgery is going to be performed under general anesthesia, it is advisable to have an empty stomach since the night before. The reason for this is that under general anesthesia, the patient's digestive system is temporarily paralyzed. There could be possibility of stomach contents coming out of the esophagus and going into the lungs. Respiratory complications could occur. Antacids are often prescribed to prevent acidity.
Ear drum repair surgery can involve repairing the damaged membrane. The conducting bones can also be damaged at times and may need to be repaired. The procedure depends on extent of damage. If damage is severe, surgery is extensive and may involve use of general anesthesia. Therefore, patient has to be admitted into the hospital a day prior to surgery.
On the day of surgery, the patient's blood pressure, pulse, breathing, body temperature are monitored after set time period. The patient is taken to the operating room and given anesthesia. It is in the form of intra-venous medicine or through the nasal route. Once the patient is completely unconscious, the surgery can be started. If the damage is restricted to a small area of ear membrane, surgery is performed under local anesthesia. The patient can visit the surgeon directly on day of surgery.
Methods/Techniques of Eardrum Repair Surgery
Depending on the degree of damage, the surgery can be performed in the following ways:
- For a Small Perforation: If the ear drum is not extensively damaged, then the surgery can be performed on out-patient basis. There is no need to get admitted in the hospital. The surgeon uses local anesthesia to numb the internal ear. The perforated membrane is sealed by using gel or other healthy tissue.
- For a Larger Perforation: If the membrane is damaged extensively, then the patient will be operated under general anesthesia. A small surgical incision is given behind the ear opening. This incision is used to insert surgical tools and seal the damaged membrane using tissue from a healthy vein or fascia.
- For Damaged Bones: If the malleus, incus or stapes is damaged, the surgery becomes more extensive. Under general anesthesia, a small cut is given behind the ear. A microscope may be inserted into the ear to visualize the smaller structures better. The damaged membrane is patched using a suitable graft as described in the previous surgery. Damaged bones may need to be replaced with suitable grafts.
- Immediately After Surgery: If surgery is performed under local anesthesia, the patient can be sent home soon after the procedure is over. However, if general anesthesia is used, the patient may have to stay back at the hospital for a day.
- Ear Care: The ear is packed with surgical dressing. The dressing must be changed as per the surgeon's instructions. The ear has to be kept clean and dry. While having a bath, water must not enter the operated ear.
- Wound Care: If a surgical incision is needed for the procedure, it is sutured using surgical thread. Care has to be taken till it heals. The incision must remain dry. Any sign of bleeding or infection should be reported immediately to the doctor.
- Medicines: After surgery for eardrum repair, the patient is usually prescribed painkillers and antibiotics. This is to take care of pain and infection respectively, which could occur after surgery.
- Prevention of Further Damage: To avoid further damage to the operated ear, the patient must avoid exposure to loud noises. It is not advisable to listen to music using earphones. Care must be taken to avoid infection which can lead to coughing and sneezing. This can put pressure on the ears. The surgical wound may not heal well. Soft food which is easy to swallow must be consumed. The ear canal is internally connected to the throat. Hence, excessive chewing action and eating food which is difficult to swallow may put extra pressure on the internal ear.
Risks and Complications
Eardrum repair surgery is at times associated with certain complications which could occur during or after the procedure. But these can be controlled using appropriate treatment methods. Some of the complications have been listed below:
- Bleeding: Bleeding could occur if any blood vessel passing adjacent to the ear is mistakenly damaged during surgery. Bleeding will obscure the surgeon's view of the internal ear. Bleeding is controlled by sealing the open ends of blood vessels with electrocautery. Accumulated blood can be removed using a tube to drain it away.
- Incomplete Repair of Eardrum: At times, despite the best efforts by surgeon, the eardrum membrane may not be patched properly. In such cases of ear infections, hearing loss may occur. Operating up on the defect again may be considered at some other time. In the mean while, antibiotics can be used to treat any existing ear infections.
- Accidental Injury: Organs adjacent to the eardrum or ear bones, like nerves, muscles can suffer damage from surgical tools during surgery. The damage can be repaired during surgery itself as seen fit by the surgeon.