The ear drum is composed of two parts, a pars tensa which accounts for the majority of the visible drum and the pars flaccida which accounts for the upper one fifth of the ear drum. Sound is transmitted through the eardrum to the ossicles (tiny bones of the middle ear), these in turn transmit the sound to the cochlea (organ of hearing). Occasionally due to ear disease, trauma or significant infections a perforation / hole in the ear drum occurs. When this happens the patient may be completely asymptomatic but often they have a degree of discharge from the ear and possibly some hearing loss. The degree of hearing loss depends on the integrity of the small bones in the ear and the size / position of the perforation.
The hole / perforation in the eardrum can be repaired using an operation called a ‘myringoplasty’. This operation can sometimes be done through the ear canal but occasionally an incision is used behind the ear or above it. The perforation edges are freshened to encourage new growth and a graft is placed under the eardrum as a template for the new drum to grow over. The ear canal then has a dressing placed inside it and this usually comes out some 7-10 days later in the Out-patient clinic.
There is a failure rate associated with the operation and this is dependant on the site of the perforation and the size. Occasionally people feel slightly unsteady following the operation. It is important not to undertake any heavy lifting or blowing of the nose in the postoperative period as this changes the middle ear pressures and it may cause graft failure. The ear and dressing must be kept meticulously dry in the post-operative period until the surgeon agrees for the patient to go swimming again.