Myringoplasty is a surgical procedure that repairs a hole (perforation) in the eardrum. It differs from the closely related tympanoplasty in one important way: myringoplasty patches the eardrum itself without entering the middle ear space behind it. Tympanoplasty, by contrast, involves lifting a flap and working inside the middle ear. Because myringoplasty is less invasive, it typically means a shorter operation and a simpler recovery.
Why It’s Done
Most ruptured eardrums heal on their own within a few weeks. Myringoplasty becomes an option when that natural healing doesn’t happen. The usual threshold is a perforation that hasn’t closed after about three months of watchful waiting. Other common reasons include chronic or recurring ear infections that keep re-opening the eardrum, hearing loss caused by the perforation, or significant trauma to the ear.
Before recommending surgery, doctors will generally try conservative approaches first, such as keeping the ear dry and treating any infection with drops or oral antibiotics. Myringoplasty is the next step when those measures aren’t enough.
How the Procedure Works
The surgeon patches the perforation using a small piece of your own tissue as a graft. The most common graft material is a thin layer of tissue taken from above the ear (called temporalis fascia), though cartilage or its lining from the outer ear can also be used. For very small perforations, a simpler technique called fat plug myringoplasty uses a tiny piece of fat, often harvested from the earlobe, pressed into the hole. This version can sometimes be done as an office procedure rather than in an operating room.
Surgeons can access the eardrum through the ear canal itself (a transcanal approach) or through a small incision behind or in front of the ear. Newer endoscopic techniques use a thin camera inserted through the ear canal, which avoids any external incision and gives the surgeon a wide-angle view of the eardrum. Traditional microscope-based surgery offers the advantage of freeing both hands, but the endoscope can visualize hard-to-reach areas without removing any bone, making it especially useful for patients with narrow or curved ear canals.
Adults often have the option of local anesthesia with mild sedation for straightforward repairs. Children almost always receive general anesthesia because they have difficulty tolerating the noise, pressure changes, and prolonged positioning the surgery requires.
Success Rates
Myringoplasty has a strong track record. For a first-time repair, graft closure rates are around 85% to 97%, with most large studies landing near 85% or higher. One study of 116 primary procedures reported a 96.6% success rate. When the graft heals properly, most patients also see meaningful hearing improvement, with the majority achieving a hearing gap of 20 decibels or less between bone and air conduction, which is close to normal function.
If a first repair fails, a revision surgery is still a reasonable option, though success rates are somewhat lower. Revision procedures typically achieve graft closure in about 78% to 90% of cases. Hearing outcomes after revision surgery are statistically similar to those after the first operation, so a failed initial repair doesn’t mean the ear can’t ultimately be fixed.
Fat Plug Myringoplasty for Small Holes
For small, dry, centrally located perforations, fat plug myringoplasty is a quicker alternative. A small piece of fat is tucked into the perforation from both sides, essentially plugging it. One prospective study of 20 procedures achieved a 90% closure rate at six months of follow-up. Because it’s minimally invasive and can be performed in a clinic setting, it’s a popular choice for straightforward cases, particularly in children who might benefit from avoiding a longer operation.
Risks and Complications
The most significant risk is graft failure, where the patch doesn’t take and the perforation remains open or reopens. This happens in roughly 3% to 15% of first-time surgeries depending on factors like perforation size and the patient’s infection history.
A less well-known risk involves a tiny nerve called the chorda tympani, which runs through the middle ear space and controls taste sensation on one side of the tongue. Even in procedures that don’t formally enter the middle ear, this nerve can be stretched or irritated. In one large study of middle ear surgeries, about 43% of patients reported some taste disturbance at 10 days after surgery. That number dropped to 23% by four months and fell to just 9% at one year. Some patients also experience temporary tongue numbness on the affected side. If the nerve is only stretched rather than cut, the odds of full recovery are much higher.
Other possible complications include temporary dizziness, mild ear pain, and in rare cases, worsened hearing. Serious complications like permanent hearing loss are uncommon.
Recovery and Aftercare
Keeping water out of the ear canal is the single most important rule after surgery. For the first few days, you should avoid washing your hair, and once you resume, a cotton ball coated in petroleum jelly or a similar barrier can help protect the ear. Swimming is off-limits until the surgeon gives clearance, which may take several weeks.
Nose blowing should be avoided for at least two weeks because the pressure travels through the tube connecting your nose to your middle ear and can dislodge the graft. If you need to sneeze, keep your mouth open rather than holding it in. Chewing gum and blowing bubbles are also restricted for about two weeks. Wind instruments like trumpets or clarinets are off the table until your surgeon clears you.
Physical activity should be limited to quiet, low-impact movement in the early weeks. Contact sports, heavy lifting, and bending over are all restricted until a follow-up visit confirms the graft is healing. Sleeping on the opposite ear helps avoid putting pressure on the surgical site.
Most people notice their hearing is muffled immediately after surgery due to packing material inside the ear canal. As the packing dissolves or is removed and the graft integrates with the surrounding eardrum tissue, hearing gradually improves over several weeks. Full healing of the graft typically takes two to three months, and the final hearing result may not be apparent until that point.