Myringoplasty

Myringoplasty (Latin: myringoplastica) is a surgery to close a defect (perforation) of the tympanic membrane. It is a type of tympanoplasty that restores the integrity of the eardrum alone, without reconstructing the ossicles.

The main goal of the procedure is to seal the middle ear, protecting it from external factors and infection, while also improving hearing. Restoring the integrity of the tympanic membrane reestablishes normal sound conduction and helps reduce conductive hearing loss.

Indications for Tonsillectomy

Myringoplasty is indicated for perforations of the tympanic membrane that fail to heal spontaneously. A key requirement for surgery is the absence of active purulent infection in the middle ear.

Main indications:

• Chronic otitis media: Chronic purulent middle otitis media with a persistent dry perforation.
• Traumatic perforation: Perforations resulting from injury (e.g., blunt trauma or barotrauma) that have not healed after several months of conservative treatment.
• Hearing loss: Conductive hearing loss caused by the perforation.

Surgical Technique and Objectives

The perforation is closed using a graft that acts as a scaffold, allowing the patient’s own tympanic membrane tissue to grow and cover the defect. The graft material is most often autologous, meaning it is taken from the patient’s own tissue.

Common graft materials:

• Temporal fascia: A thin yet strong layer of connective tissue.
• Perichondrium or tragal cartilage: Small pieces of cartilage taken from the auricle.

The surgeon carefully prepares the edges of the perforation to stimulate tissue growth. The graft is then placed under the defect, on the side facing the middle ear. Over time, it integrates with the surrounding tissue, and the perforation becomes fully closed.

Comparison with Other Procedures

Myringoplasty corresponds to a Type I tympanoplasty according to Wullstein classification and involves only the tympanic membrane. It should be distinguished from more complex hearing-restoring procedures, which may involve ossicular reconstruction or other interventions. If the ossicles are also damaged or destroyed, reconstruction of these bones is performed through ossiculoplasty. In cases where there is chronic mastoid inflammation (mastoiditis), the procedure may be combined with a mastoidectomy to remove the affected tissue.