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myringoplasty

A surgery to repair a hole in the eardrum. The closure of the perforation of pars tensa of the tympanic membrane. If the perforation is from recent trauma, just to watch and see if it heals on its own, because it does in 90% of the cases. However, if it doesn't within 3 months, it is vulnerable to infections and may cause temporary hearing loss. Therefore, surgery is required. The hole is repaired by placing a graft made of either a small piece of tissue from elsewhere on the body, or a gel-like material. (Graft materials) • temporalis fascia (most common) • tragal cartilage • tragal perichondrium • fascia lata • vein • dura • skin • allografts: acellular dermal matrix (AlloDerm), biological graft extracted from porcine small intestinal submucosa (Surgisis) Cartilage is the best for rigidity and resistance to resorption, and nourished well. Fascia and perichondrium go atrophy. Skin graft tends to induce infection. (Comparison) • myringoplasty: repair of the tympanic membrane alone • tympanoplasty: more extensive rebuilding of the tympanic membrane and removing scar tissue • ossiculoplasty: repair or replace of the ossicles behind the tympanic membrane (Incision approach for tympanoplasty) • Endomeatal (Transcanal) approach • Endaural approach • Postaural approach (Techniques of placement of graft) • Palisade technique • Underlay technique • Overlay technique • Interlay technique • Double breasting technique Cf. cholesteatoma