Tympanoplasty in KPHB, Hyderabad

It is done at Sinocare ENT Hospital, usually while you are fully asleep (general anaesthetic). Some adults have it awake, with numbing medicine (local anaesthetic) and a sleepy medicine (sedation). It takes about an hour to ninety minutes. Most patients go home the same day, with a dressing in the ear canal. The dressing comes out at the hospital in the second or third week. Desk work starts again in a few days to a week. Water, flying and heavy effort wait until you are cleared. Hearing is properly judged with a repeat hearing test at eight to twelve weeks.

A hole in the eardrum that has stayed open for more than three months will not close on its own. Drops will not close it either. Surgery is discussed when you have:

• An ear that discharges every time water gets in, or every time you catch a cold
• Hearing that has dulled on that side. The hearing test usually shows sound is not being carried through (a conductive loss).
• A hole seen on examination that has not healed after a fair trial of treatment
• A wish to swim, dive, or work somewhere dusty without an open ear

A dry hole in an ear that hears well and never gives trouble does not have to be operated on. That is a real option, and you are told when it applies to you.

The patch is placed under or over the edges of the hole. The eardrum then heals across it, the way skin heals across a graft. The way in is usually through the ear canal, with a camera (endoscope) or a microscope, and no visible cut. Sometimes the hole sits where the canal will not give a clear view. Then a small cut tucked behind the ear is used. That scar settles into the crease and cannot be seen from the front.

Most tympanoplasties take around an hour to ninety minutes. Adults can have it awake, with numbing medicine and a sleepy medicine, or fully asleep. Children have it fully asleep.

• A hearing test (audiogram). It separates hearing loss from the eardrum and the bones (conductive loss) from loss in the nerve. This decides whether surgery will help, and how much it can help.
• The ear must be dry. An ear that is still discharging is treated first, sometimes for weeks, with drops and cleaning. Placing a patch on a wet ear invites failure.
• A CT of the ear bone (temporal bone) in two cases. One is when cholesteatoma (a growth of skin trapped in the wrong place) is suspected. The other is when the hearing loss is larger than the hole explains.
• Stop blood thinners only on the advice of the doctor who prescribed them.

First week. A dressing or pack sits in the ear canal. Expect blockage, a hollow sound, mild pain, and some clear or blood-tinged staining on the outer dressing. The ear must stay dry.

Weeks two to three. The pack comes out at the follow-up visit. Hearing at this point is often no better than before surgery, and sometimes worse. That is because the canal is still swollen and the patch is still thick. This is expected. It is not a sign that the operation has failed.

Weeks four to eight. The patch slowly becomes like an eardrum. Hearing is checked again with a repeat hearing test at around eight to twelve weeks. That is the honest point to judge the result.

Throughout. No blowing your nose with the nose pinched shut, and no straining. No flying for as long as advised, and no water in the ear until you are cleared. Ordinary desk work starts again in a few days. Gym, swimming and contact sport wait.

• The patch does not take. Some holes open again. This is more common in ears that were discharging beforehand, in large holes, and in smokers. Operating only on a dry ear is the main guard. A repeat operation is possible.
• Hearing does not get better, or, rarely, gets worse. Closing the eardrum reliably stops the discharge. How much hearing comes back depends on the state of the hearing bones. Sometimes that can only be fully seen once the ear is open. The hearing test beforehand sets a fair expectation.
• A change in taste. A nerve carrying taste from the front of the tongue runs across the middle ear. Stretching it gives a metal taste or numbness on that side of the tongue. It usually settles over weeks to months.
• Ringing in the ear (tinnitus) and dizziness. Common for a short time after surgery, uncommon as a lasting problem.
• Infection of the patch or the wound, treated with antibiotics.
• Severe hearing loss on the operated side. Rare. It is the reason a well-hearing ear is never operated on lightly.