Myringoplasty

The eardrum is a membrane that separates the outer ear from the middle ear and forms the end of the external auditory canal. It is shaped like a flattened cone, like a Chinese hat, with the tip pointing towards the inside of the skull. The tip, which corresponds to the point of attachment of an ossicle: the malleus, is only 2 mm deeper than the edges. Its average height is 10 mm and its width 8 mm. It is slightly oriented downwards and outwards in its most anterior part, so its surface area is larger than the cross-section of the external auditory canal, i.e. around 60 mm2. The S-shape of the external auditory canal partially protects it from external mechanical aggression. It has 2 distinct zones separated by integrated tympanomalleolar ligaments:

• The pars tensa: located below the ligaments, this accounts for the greater part of the eardrum (85%). This portion is the most rigid. From outside to inside, it is made up of three layers: an epithelial layer, which is the continuity of the skin of the auditory canal and outer ear; a fibrous layer, the lamina propria, containing collagen fibers; and a mucous layer, which is the innermost layer. The eardrum’s plasticity and elasticity enable it to vibrate in response to sound.
• The pars flaccida or schrapnell membrane, above the ligaments, is smaller in size (15%) but lacks the intermediate fibrous layer that makes it more fragile.

The procedure is performed under general anesthesia in an outpatient operating room, unless there are contraindications. A small skin incision (1 to 1.5 cm) is made, either in front of the ear or slightly further back (2 to 2.5 cm), depending on the technique chosen by the surgeon. The principle is to place a support (the graft) on which the healthy eardrum can rest to fully reconstitute itself. The graft closes the perforation, but the eardrum that grows back onto the graft ensures that the middle ear remains watertight. The edges of the perforation must therefore be brightened to encourage regrowth. The graft used remains in place (except for fat) even after the eardrum has regrown, modifying its elastic and plastic qualities. The graft is taken from the patient’s body to ensure perfect compatibility, and can be made up of muscular aponeurosis and/or cartilage, or fat taken from the surrounding tissue through the skin incision, or from around the umbilicus in the case of fat. A healing dressing is placed in the ear canal for 10 to 15 days.
When the graft is placed under the eardrum in the middle ear, it is said to be in “underlay” which is the most common case (fascia or cartilage).
When the graft is placed like a plug in the perforation (fat or butterfly cartilage), it is said to be in “inlay”.
When the graft is placed on the external face of the tympanum at the connective level, it is said to be in “overlay or onlay”.

In the case of outpatient surgery, the patient returns home the same day.
After hospitalization, you must remain at home for 10 days, resting and not putting any liquid in your ear other than the prescribed drops.
The surgeon will give you 10 to 15 days off work.
Sport is not recommended for the first 15 days, and should be resumed gradually.
Swimming and diving are not recommended until your surgeon has advised you.
Flying is not recommended for 2 months.
Pain is slight, sometimes increased when chewing. It is soothed by class I analgesics such as paracetamol, and usually disappears within a week.
Post-operative care at home: ear drops to keep the healing dressing moist and effective, ear protection, analgesics, nursing care of scar.
Scar: barely visible scar in front (1-1.5 cm hidden behind the hairline) or behind the ear (2-2.5 cm).