A tympanic membrane perforation sounds like a scary and severe condition. However, it is only another name for a perforated or ruptured eardrum (which is medically called the tympanic membrane). In this condition, a hole or tear occurs in the thin tissue separating your ear canal from the middle ear.

There may be several causes for a perforation of the eardrum. An infection in your middle ear (otitis media), air pressure changes, head injury, loud sounds, or something as seemingly harmless as a cotton swab in your ear. 

Eardrum perforation may heal on its own and may not cause any problems. However, sometimes, it can cause frequent ear infections due to water getting into the ear or loss of hearing on account of reduced vibrations of the eardrum. 

An ENT (ear, nose, and throat) specialist doctor identifies the hole in your eardrum by using an instrument called an otoscope/auriscope. 

The procedure for the repair of a perforated eardrum is called a myringoplasty - “myringo” stands for “eardrum” and “plasty” stands for “repair of”. Let’s find out more about it. 


Graft Materials 

The ENT Surgeon will use a graft material, which is the material used to patch the eardrum. These materials can be:

  • Paper: For a pinhole perforation.

  • Fascia: A thin casing of connective tissue taken from behind the ear (temporalis fascia).

  • Perichondrium: A dense layer of fibrous connective tissue taken from the front of the ear (tragal perichondrium).

  • Cartilage: A strong and flexible fibrous tissue taken from the tragus - the cartilaginous protrusion in the front of the ear.

  • Periosteum: A membrane that covers the outer surface of all bones and is used for very large perforations.


Depending upon the size and location of the perforation, as well as the personal preference of the surgeon, the eardrum can be approached in various ways:

  • Permeatal: Through the ear canal and no incision is made outside the ear. 

  • Post-aural: Behind the ear.

  • Endaural: From the front and above the ear. 


In order to perform a successful myringoplasty, these conditions should be present: 

  • A dry ear.

  • A fully functional Eustachian tube (a small canal that connects your throat to your middle ear and equalises air pressure on both sides of the eardrum).

  • An adequate air-bone gap (the difference between the results of air conduction and bone conduction tests in an audiogram).


Myringoplasty consists of the following steps:

1. The surgery can be performed under:

  • Local anaesthesia: By local injections of an anaesthetic agent.

  • Monitored anaesthesia care: Local anaesthesia is coupled with sedation and analgesia (loss of the sensation of pain).

  • General anaesthesia: Complete unconsciousness.

2. The surgeon prepares the graft material.

3. The edges of the perforation in your eardrum are freshened with an instrument so that healing of the perforation can happen.

4. The entire tympanomeatal flap (flap cut in the tympanic membrane) is elevated and the graft is slipped underneath, over a bed of gelatin sponge placed deep in the middle ear. 

5. The graft is placed against the eardrum. 

6. The flap is then replaced and the ear is packed with a medicated gauze.

7. You may have an external dressing and a head bandage for a few hours after surgery to protect your ear canal.

8. You could be called between days 5 to 7 for follow up and removal of sutures.

9. The pack inside the ear is removed between days 10 to 14.

10. Complete recovery from myringoplasty takes about 4 to 6 weeks.

Post-Surgery Precautions 

1. You must keep the operated ear dry. 

2. Avoid flying (air travel) for about 4 weeks after the surgery to prevent air pressure changes from damaging the healing eardrum.

3. Report any concerning symptoms such as swelling, bleeding, pain, or fever to the doctor immediately. 

Take good care of your ears to avoid any preventable injuries and trauma. Remember, you do not need to clean your ears, even with a cotton swab. Your ears are self-cleaning. 

If you experience any problematic symptoms in your ears, consult a doctor immediately. 

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.