Myringoplasty (Eardrum Repair) — Cost, Top Hospitals & Success Rates | MyMedicPlus

Myringoplasty is an otological surgical procedure in which a perforated tympanic membrane (eardrum) is repaired using a graft of biological tissue. It is distinguished from tympanoplasty — a broader term encompassing myringoplasty plus reconstruction of the middle ear ossicles — in that myringoplasty repairs the drum alone without addressing the ossicular chain.

The tympanic membrane serves as both a sound-transmitting structure and a protective barrier separating the middle ear from the external environment. A perforation causes two main problems: conductive hearing loss (sound energy bypasses the normal ossicular pathway) and recurrent middle ear infections (otitis media) because pathogens can enter through the opening.

The surgeon harvests a thin piece of the patient's own tissue — most commonly the temporalis fascia (a layer of connective tissue behind and above the ear) — and uses it as a scaffold over or under the drum remnant. The graft becomes vascularised and integrates with the existing eardrum within weeks.

Modern myringoplasty can be performed through a post-auricular (behind-the-ear) incision or endoscopically through the ear canal, avoiding any external incision. The endoscopic approach has become increasingly standard at specialist centres.

Myringoplasty addresses perforations and their consequences:

• Chronic tympanic membrane perforation — a perforation that has persisted for more than 3 months following acute otitis media or trauma, defined as chronic when it fails to close spontaneously
• Traumatic perforation (non-healing) — caused by barotrauma (e.g., slap to the ear, blast injury, diving, air travel), direct injury, or iatrogenic perforation from ear syringing; most heal spontaneously but persistent perforations (>2–3 months) benefit from surgical closure
• Conductive hearing loss secondary to perforation — a central perforation typically causes 15–30 dB conductive hearing loss depending on size; closure restores sound transmission
• Recurrent otitis media — patients with perforations who experience repeated episodes of mucopurulent discharge triggered by water entry or upper respiratory infections
• Prevention of cholesteatoma — marginal perforations, particularly in the pars flaccida, carry a risk of squamous epithelium ingrowth (cholesteatoma); early closure reduces this risk

Surgical success depends critically on patient selection and pre-operative preparation:

• Dry ear requirement — the operative site should be free of active infection and discharge; most surgeons prefer a dry ear for 3–6 months before elective surgery; aggressive pre-operative topical antibiotic treatment is used to achieve dryness
• Eustachian tube function — the Eustachian tube equalises middle ear pressure; persistent dysfunction (common in children and after chronic infection) increases graft failure risk; surgeons may test tube function with a Valsalva manoeuvre or tympanometry
• Perforation characteristics — central perforations of the pars tensa with an adequate drum remnant for graft anchoring are most amenable; large or subtotal perforations have slightly lower success rates but remain suitable
• Age — myringoplasty is generally deferred until age 7–8 in children because Eustachian tube function matures during early childhood; earlier surgery is appropriate if significant hearing loss impairs speech development
• Only-hearing ear — surgery on an only-hearing ear requires especially careful pre-operative counselling given the small risk of further hearing loss
• Contralateral ear status — disease of the contralateral ear may need to be addressed first or simultaneously

Technique selection depends on perforation size, location, surgeon expertise, and patient anatomy:

• Underlay (medial) technique — the most widely used approach; the graft is placed medial (deep) to the drum remnant, supported by absorbable gelfoam in the middle ear; provides good vascularity and is suitable for most perforation sizes; associated with high graft take rates (88–95%)
• Overlay (lateral) technique — the graft is placed lateral (superficial) to the drum remnant after the epithelial layer is elevated; provides excellent visualisation for anterior perforations that are difficult to reach; slightly higher risk of lateralisation of the graft or epithelial migration
• Onlay technique — a hybrid: the drum epithelium is preserved and the graft placed between epithelial and fibrous layers; used for specific anatomical situations
• Fat plug myringoplasty — for small perforations (<2 mm); a plug of fat harvested from the ear lobe is placed through the perforation under local anaesthesia in an office or clinic setting; success rate 80–90% for tiny perforations with minimal morbidity
• Endoscopic myringoplasty — a rigid 3 mm endoscope is passed through the ear canal, eliminating the need for a post-auricular incision; provides wide-angle panoramic view; shorter operation, less post-operative pain, no visible scar; now comparable to microscopic technique in published graft take rates
• Graft materials — temporalis fascia (gold standard), tragal perichondrium, cartilage-perichondrium composite (superior in Eustachian tube dysfunction), and temporoparietal fascia are the main autologous options

Successful myringoplasty confers multiple functional and quality-of-life benefits:

• Hearing restoration — closure of the perforation improves conductive hearing loss by 15–30 dB in the majority of patients; audiometric improvement is seen in 80–90% of successful repairs
• Prevention of recurrent infection — a closed eardrum prevents water entry and pathogen access to the middle ear, dramatically reducing episodes of otorrhoea and otitis media
• Water sports and bathing freedom — patients with perforations must protect the ear from water indefinitely; successful repair removes this restriction permanently
• Reduction in cholesteatoma risk — closing marginal and attic perforations prevents ingrowth of squamous epithelium
• Avoidance of hearing aids — in many patients, successful surgical repair restores hearing to levels that negate the need for amplification
• High success rate — graft take rates of 85–95% are consistently reported in prospective studies; long-term closure is maintained in the vast majority

Myringoplasty is a low-risk procedure but carries specific complications the patient should understand:

• Graft failure (10–15%) — the most common complication; more frequent with large perforations, Eustachian tube dysfunction, active infection at the time of surgery, or smoking; re-grafting (revision myringoplasty) is usually successful
• Residual or recurrent hearing loss — despite intact graft, conductive hearing loss may persist if the ossicular chain was damaged by prior infection; sensorineural hearing loss from drill-induced noise is rare but documented
• Tinnitus — may develop or worsen post-operatively; usually transient
• Dizziness / vertigo — brief dizziness is common in the immediate post-operative period; prolonged labyrinthine disturbance is rare
• Taste disturbance — the chorda tympani nerve (branch of facial nerve supplying taste to anterior two-thirds of tongue) passes through the middle ear; manipulation or division causes metallic taste or loss of taste sensation on the affected side, usually transient but occasionally permanent
• Facial nerve injury — extremely rare (<0.1%); the facial nerve runs through the middle ear and requires careful identification during surgery
• Perforation recurrence / re-perforation — may occur years later following upper respiratory tract infections if underlying Eustachian tube dysfunction persists

Post-operative care is straightforward but critical for graft survival:

• Ear packing — absorbable packing (Gelfoam or Surgicel) fills the ear canal and dissolves over 2–4 weeks; non-absorbable dressings are removed at the first follow-up visit (1–2 weeks)
• Water precautions — the ear must be kept strictly dry for 6–8 weeks; cotton wool with petroleum jelly (Vaseline) is used during showering and hair washing; swimming is avoided for a minimum of 8 weeks and often until surgical clearance at 3 months
• Nose blowing and Valsalva — forceful nose blowing and sneezing with the mouth closed are avoided for 4–6 weeks to prevent positive middle ear pressure displacing the graft
• Air travel — aviation pressure changes are generally safe once the ear is healed (after 4–6 weeks); use of decongestants before flights is advisable in the early recovery period
• Hearing assessment — pure tone audiometry is performed at 3 months post-operatively to document hearing improvement
• Follow-up schedule — clinic visits at 1–2 weeks (packing removal, wound check), 6–8 weeks (microscopic examination of drum), 3 months (audiometry and otoscopy)
• Return to work — most patients return to sedentary work within 1–2 weeks; heavy physical labour may be deferred to 3–4 weeks

Myringoplasty is generally one of the more affordable ENT surgical procedures:

• Approach — endoscopic myringoplasty (no post-auricular incision, shorter theatre time) may cost less than microscopic post-auricular approach; office-based fat plug myringoplasty for tiny perforations is least expensive
• Country and facility — India offers myringoplasty at accredited ENT centres for $500–$1,500; Thailand $1,000–$2,500; UK (NHS): no cost to eligible patients; UK (private) £2,000–£4,500; USA $4,000–$8,000
• Anaesthesia type — local anaesthesia with sedation reduces costs versus full general anaesthesia; adult cooperative patients may be suitable for local anaesthesia
• Revision surgery — second procedures for graft failure attract surgeon fees but are generally less complex than the primary operation
• Pre-operative assessment — audiometry, tympanometry, and CT scanning (if cholesteatoma is suspected) add to total pre-operative costs

Not all perforations require surgery, and alternatives exist for different situations:

• Conservative management and watchful waiting — small, asymptomatic, dry perforations in patients without hearing difficulties or recurrent infection may be safely observed; some close spontaneously over months
• Topical antibiotic treatment — control of active otorrhoea with topical ciprofloxacin or framycetin/gramicidin drops is a long-term management strategy for patients unfit for or unwilling to undergo surgery
• Tympanoplasty (type II–IV) — if ossicular chain damage accompanies the perforation, more extensive reconstruction is required; simple myringoplasty is inadequate in these cases
• Paper patch myringoplasty — a temporary adhesive paper patch (cigarette paper, wound closure strip) applied over the perforation in clinic stimulates epithelial migration and may close small perforations in selected patients without anaesthesia; success rate 50–75% for small perforations
• Hearing aids — for elderly or medically unfit patients in whom surgical risk outweighs benefit, a hearing aid provides functional hearing restoration without operative risk; does not address recurrent infection