Tympanoplasty: Repairing a Perforated Eardrum
A hole in the eardrum can leave you dealing with hearing loss, recurring ear infections, and constant discomfort. Tympanoplasty is the surgery that rebuilds the eardrum so your ear can work properly again. Here's what causes a perforation, how the repair is done, and what recovery looks like.
What Is Tympanoplasty?
Tympanoplasty is a surgical procedure to repair a perforated (torn or holed) eardrum, and in some cases to reconstruct the small bones of the middle ear as well. The eardrum, or tympanic membrane, is a thin sheet of tissue that vibrates in response to sound and passes that vibration to the middle ear bones. When it develops a hole, sound transmission is disrupted, and the middle ear is left exposed to bacteria and water, making infections far more likely.
What Causes a Perforated Eardrum?
- Chronic or repeated ear infections (otitis media), which are the most common cause
- Trauma — a direct blow to the ear, a cotton swab pushed in too far, or a slap to the side of the head
- Barotrauma from sudden pressure changes, such as during flying or scuba diving
- Loud blast or explosion injuries
- Previous ear surgery or a long-standing ventilation tube that leaves a residual hole
The eardrum (tympanic membrane) sits between the outer and middle ear
Signs and Symptoms
- Hearing loss or a feeling of muffled sound in the affected ear
- Ear discharge — clear, bloody, or pus-like
- Recurrent ear infections that don't fully clear up
- Ear pain, especially right after an injury
- Ringing in the ear (tinnitus) or occasional dizziness
Some small perforations heal on their own within weeks. Surgery is usually considered when the hole persists beyond two to three months, keeps getting infected, or is causing noticeable hearing loss.
How the Surgery Works
- Anesthesia. Tympanoplasty can be done under local anesthesia with sedation or general anesthesia, depending on the size of the repair and the patient's age.
- Accessing the eardrum. The surgeon works through the ear canal, or occasionally through a small incision behind or above the ear, using a microscope or endoscope for magnification.
- Grafting. A small piece of the patient's own tissue — commonly taken from the temporalis muscle covering (fascia) or the cartilage of the tragus — is used as a graft to patch the perforation.
- Placing the graft. The graft is positioned under or over the remaining eardrum tissue so it can knit together as it heals.
- Ossicular repair, if needed. If the tiny middle-ear bones (malleus, incus, stapes) have been damaged, they may be reconstructed in the same sitting — this combined procedure is sometimes called ossiculoplasty.
- Packing. The ear canal is usually packed with a dissolvable material to hold the graft in place while it heals.
Recovery Timeline
- First few days: Mild pain, a feeling of fullness, and temporarily reduced hearing are normal as the packing sits in place.
- 1–2 weeks: Ear canal packing is usually removed at a follow-up visit; stitches (if any) are checked.
- 4–6 weeks: The graft continues to heal and hearing gradually improves as swelling settles.
- Water precautions: Keeping the ear completely dry — no swimming, and using a shower plug — is essential until your surgeon confirms the graft has healed.
Risks and Considerations
- Graft failure, requiring a repeat procedure
- Infection
- Temporary or, rarely, permanent change in hearing
- Taste disturbance if a nearby nerve (chorda tympani) is affected
- Dizziness in the first few days
Success rates for tympanoplasty are high, with most studies reporting graft success in roughly 85–95% of cases.
The middle ear and mastoid bone lie just behind the eardrum
The Takeaway
A perforated eardrum is uncomfortable and can affect your hearing, but tympanoplasty is a well-established, highly successful procedure that restores both the structure of the eardrum and, often, the hearing that was lost. If you have persistent ear discharge, hearing loss, or an eardrum that won't heal on its own, an ENT evaluation is the right next step.