Eardrum Perforation and Repair

Where is the eardrum, what does it do?
The eardrum is an airtight, thin membrane, slightly more than one cm in diameter, that separates the middle ear cavity from the external environment. The middle ear cavity is an air-filled space in our ear bone. It has a connection with the back of our nose, namely the back of our nose, through a channel called the Eustachian duct. The air in the middle ear decreases by being absorbed by the tissues over time, so it needs to be renewed. With movements such as yawning and swallowing, a small amount of air enters the middle ear cavity from our nasal cavity; at other times, this channel remains closed and prevents the microbes in our nose and nasal passages from reaching the middle ear. In cases where the Eustachian canal does not work well, the air in the middle ear decreases over time and the eardrum collapses. The task of the middle ear cavity is to amplify sound vibrations and transmit them to the inner ear fluids. Sound waves coming from the external environment are collected by the auricle and directed to the ear hole, proceeding along the external ear canal to reach the eardrum. The eardrum collects these vibrations from the air and vibrates the middle ear ossicles called anvil, hammer and stirrup, which are in contact with each other, respectively. It is in contact with the inner ear fluids through the base of the last ossicles, the stirrup. The vibration passes into the inner ear fluids and reaches the brain by transforming into nerve signals through the snail shell-shaped organ called the cochlea. The middle ear ossicles are the smallest bones in the human body, in millimetric sizes. Thanks to their shape and the angle they make with each other, they strengthen the sound vibrations to a certain extent.

How is the eardrum pierced?
Most eardrum perforations occur as a result of middle ear infections in childhood. In most cases these are small holes and heal without problems. However, sometimes the eardrum hole is large, or serious and dangerous inflammations in the middle ear accompany the picture.
Sudden pressure differences during an explosion or diving and flight also cause the eardrum to perforate by being forced by pressure. This picture often occurs when there is an upper respiratory tract infection. For this reason, while having a cold or flu, you should not fly without consulting your doctor.
The eardrum can be perforated as a result of sharp objects pricking into the ear (such as ear cleaning sticks), blows such as slaps to the ear, or bone fracture lines passing through the ear bone during head traumas.

What are the drawbacks of having a hole in the eardrum?
People with a perforated eardrum often experience ear infections. If water escapes into the ear or the patient has a cold, there is an inflamed discharge from the ear canal, this problem does not heal on its own unless antibiotic drops are used. People with a perforated eardrum should therefore protect their ears from water while in contact with water. Each inflammation can cause more serious problems by destroying the ear a little more over time. Among them, it is possible to count nervous hearing loss, dizziness, facial paralysis. The hole in the membrane may cause different degrees of conductive hearing loss in the patient's hearing, depending on the size of the hole and the degree of damage to the middle ear ossicles. If ear infections are not treated properly, they may rarely go beyond the ear bone and cause serious infections in the surrounding tissues and especially in the head. In this case, very dangerous problems such as abscess behind the ear, abscess on the neck, abscess of the brain or cerebellum, meningitis may occur. It should not be forgotten that ear infections were a frightening disease that could be fatal before antibiotics were available.

What should people pay attention to with a perforated eardrum?
The most important thing that a person should pay attention to in the ears with a hole in the eardrum is not to get water in the ear. In most cases, while swimming and bathing, the ear canal should be protected by plugging with materials such as vaseline cotton and soft silicone plugs. Otherwise, inflammation will be seen in the ear. Likewise, having a cold or flu causes the ears of people with a perforated eardrum to become easily inflamed. Ear discharge is a condition that requires referral to an Ear Nose and Throat doctor.

How is the eardrum repaired in surgery?
Small holes or newly formed fresh holes as a result of trauma can be stimulated to refresh and heal the edges of the hole, or the wound edges of the newly formed hole can be brought close to the end to heal itself. During this healing, a thin special material is adhered to the eardrum that will act as a mold. After the hole closes on its own within weeks, this mold is taken.
In larger or inflamed ears, this procedure will be insufficient. Ear surgeries can be performed under general anesthesia or under sedation and local anesthesia, depending on the size of the operation to be performed and the preference of the patient and the surgeon. After the muscle sheath, thinned cartilage or cartilage membrane tissue taken from a region around the ear is given the appropriate shape, the hole in the eardrum is prepared and placed in such a way that it contacts here. This placed tissue is called a patch (graft). If the placement is done correctly, within two weeks, this patch tissue integrates into the eardrum and becomes a part of it, and the hole is closed. If there are inflamed tissues in the ear that need to be cleaned during this surgery, they are also cleaned, deficiencies and disconnections in the auditory ossicles are eliminated. Ossicular deficiencies that cause hearing loss can be corrected by shaping or relocating the existing ossicles, if this is not possible, by placing prefabricated ossicle prostheses (titanium or hydroxyapetite-a chemical composition similar to bone structure).
All these ear surgeries are performed under the operating microscope and using microsurgical instruments. During ear surgeries, high technologies such as an endoscope may be needed in some cases. The surgery can be done without making an incision through the ear hole, or with incisions in the ear canal, in front of the ear or behind the ear. This decision is made according to the surgeon's preferences and the type of ear surgery. If only the eardrum hole is repaired, the surgical procedure is called myringoplasty, if the middle ear ossicles are also repaired or the inflamed tissue from the middle ear is removed, tympanoplasty is called, and if all these procedures are added to the inflamed tissues by opening the ear bone, it is called tympanomastoidectomy. In order to fix the patch membrane in place without falling, the middle ear can be supported with an absorbable buffer material called jelfom or the edges of the patch are clamped between the surrounding tissues. The patch is not attached with stitches. The new eardrum formed as a result of the repair is formed with the same or very close features with the normal eardrum, hearing becomes normal or very close to normal. However, if there is serious damage to the auditory ossicles, it may be necessary to accept a certain loss in hearing.
 
How to Cleanse Inflammation in the Ear?
If there are inflamed tissues in the ear bone during the ear surgery, the ear bone should be opened during the surgery and the tissues inside should be cleaned. This surgery is called mastoidectomy surgery. In such patients, there are ear discharges that cannot be controlled by drug treatments or that recur very often. It is possible to see the condition of the ear bone and plan the surgery with the computerized tomography film before the surgery. The cavity in the bone opened during the cleaning of the inside of the ear bone can be closed with the tissues of the patient, aeration can be provided by associating with the middle ear cavity, or the ear canal can be opened by cutting the connection with the middle ear. The space that opens into the ear canal is called the cavity, it should be checked and cleaned by the doctor at certain intervals after the surgery. Patients with a cavity in their ear should not get water in their ears. A type of inflammation called cholesteatoma is extremely dangerous. If left in the ear, it can grow over time and destroy the entire ear and cause serious complications. Ears with cholesteatoma should definitely be operated on. In some cases, it is not possible to clear all cholesteatoma. In this case, the remnants of the eardrum, the remains of the auditory ossicles and the entire ear bone should be cleaned and a large cavity covered with skin should be created inside. This surgery is called radical mastoidectomy surgery. Patients have severe hearing loss and they should not get water in their ears, but dangerous inflammation is taken under control. In a group of patients, only the inflammation in the ear is cleared and the eardrum is repaired in the first surgery. With a second operation performed 6 months later, the ossicles are repaired behind the intact tympanic membrane to restore hearing.

What are the complications of eardrum repair surgeries?
The hole in the eardrum may recur. In particular, ear problems due to eardrum collapse or cholesteatoma may recur even after years. Such patients should have follow-up examinations at regular intervals after surgery. The facial nerve, which provides facial movements, passes through the ear bone. Extremely rarely, facial paralysis can be seen after ear surgery. However, this complication is seen in patients with congenital facial nerve following a different route or in patients with diffuse cholesteatoma in ears with impaired normal ear anatomy. In these cases, the facial nerve appears in front of the surgeon in a place where it should not be and may be damaged. Taste nerve also passes through the ear, and taste changes in the mouth rarely occur after ear surgeries due to cutting or stretching. However, it is temporary in almost all patients. Hearing loss may occur rarely after surgery. In some cases, the surgeon has to sacrifice the auditory ossicles in order to completely clear dangerous types of inflammation such as cholesteatoma. If this is necessary, in most cases, hearing can be repaired with prosthetic hearing ossicles in the same surgery or in a second session. Neural complete loss of hearing may rarely occur. All of the above-mentioned complications are seen in dangerous types of inflammation that keeps the ear bone widespread, rather than in patients with a simple tympanic membrane perforation. However, it should be kept in mind that surgery is absolutely necessary in these patients, and if surgery is not performed, there is a possibility of encountering these complications eventually.

What is the chance of the patch membrane holding in eardrum surgery? What Can Cause Failure?
Failure of the patch membrane may be due to an ear infection in the early postoperative period or the slippage of the patch. Diseases such as smoking, uncontrolled diabetes, and kidney failure can reduce the chance of adhesion of the patch membrane. Although it varies depending on the problem in the ear and the type of surgery, a patient who has ear surgery can generally expect the surgery to be 90% successful.

What should the person who has undergone eardrum repair surgery pay attention to, which activities are restricted?
After a period of time that varies according to the surgeon's preference after the surgery, the ear pads are removed and medications in the form of drops are started in the ear. It is necessary to avoid movements such as nose cleaning and heavy lifting for weeks. Resting for 2-5 days is usually sufficient. Heavy work and sports activities should be avoided for a month. Air travel should not be made for 1-2 months after eardrum repair surgery. After the operation, water should not be in the ear for 3-6 months. Inflammatory or bloody discharge from the ear, except in the early postoperative period, may indicate a problem in the membrane.