New technique to repair a perforated eardrum: in 20 minutes.

February 26, 2013 by Dr Issam Saliba and Dr Musaed Alzahrani
Nouvelle technique de réparation d’un tympan perforé : en 20 minutes.
A perforated tympanic membrane is a hole in the eardrum. The eardrum is a membrane that separates the middle ear from the external auditory canal. The perforation can be caused by a middle ear infection, trauma to the ear with a cotton swab or by an impact to the ear. A perforated eardrum is diagnosed by a doctor performing an otoscopy.

A perforated eardrum causes hearing loss. Patients affected must avoid getting water in the ear with the perforated eardrum due to the potential risk of infection, which is often associated with an unpleasant discharge, even if the perforation is very small. In most cases, the tympanic membrane heals on its own. Unfortunately, it can sometimes become chronic, requiring surgical treatment.

The goal of surgical treatment is to re-establish the eardrum’s integrity to improve hearing and protect the middle ear. This procedure, called a myringoplasty or more commonly tympanoplasty, is usually performed under general anesthesia and requires a short hospital stay (one or two days) and ten days off work or school.

Dr. Issam Saliba recently developed a new myringoplasty technique. One that is less complicated than the traditional techniques. It is performed at an out-patient clinic in 20 minutes under local anesthesia. Dr. Saliba named it Hyaluronic Acid Fat Graft Myringoplasty (HAFGM). The success rate is similar to that of the conventional techniques, which is on average about 90%. However, the HAFGM technique offers much greater success compared to a myringoplasty performed with a fat graft alone.

What does this new technique consist of? The ear is anesthetized with 1% xylocaine, which is well tolerated in adults and children. Then, fat is removed through a small 5–7 mm incision at the back of the neck. After trimming the margins of the perforated eardrum under a microscope, the middle ear is filled with resorbable sponges (Gelfoam™) to provide support for the fat during healing. The prepared fat graft is put in place through the eardrum perforation to completely close the hole. It is then covered with an EpiDisc™ composed of hyaluronic acid ester, a natural constituent of the extracellular matrix. This will essentially accelerate healing. At the end of this stage, the patient can already experience a subjective improvement in hearing. This procedure lasts an average of 20 minutes and the patient can resume his daily activities on the same day. Oral antibiotics are prescribed for seven days. However, the ear must be protected from water for two months, until a follow-up appointment with the ENT surgeon confirms that the eardrum has completely healed.

This technique is effective, well tolerated and offers a success rate that is similar to a traditional myringoplasty. For more information, do not hesitate to consult your ENT specialist.