Outpatient Surgical Technique Corrects Perforated Eardrums

A revolutionary surgical technique for treating perforations of the tympanic membrane is as effective as traditional surgery and far less expensive, according to a new study.

Developed by researchers at the Sainte-Justine University Hospital Center (Montreal, Canada), the Hyaluronic Acid Fat Graft Myringoplasty (HAFGM) procedure requires only basic materials: a scalpel, forceps, a probe, a small container of hyaluronic acid, a small amount of fat taken from behind the ear, and a local anesthetic. The operation, which is performed through the ear canal, allows the body to rebuild the entire tympanic membrane after about two months on the average, allowing patients to recover their hearing completely and preventing recurring cases of ear infection (otitis). Because it requires no general anesthetic, operating theatre, or hospitalization, the technique makes surgery much more readily available, particularly outside large hospital centers, and at considerably lower cost.

Traditional Myringoplasty surgical procedures to repair the tympanic membrane or eardrum are performed using lateral and medial techniques, which require hospitalization for at least one day, and 10 to 15 days off work. The new eardrum surgery technique can be performed in 20 minutes at an outpatient clinic during a routine visit to an ear, nose, and throat (ENT specialist). The result is a therapeutic treatment that is much easier for patients and parents. The technique is based on the results of a four-year prospective cohort study of 208 children and adolescents, 73 of whom were treated using the new HAFGM technique; the study was published on December 16, 2011, in Archives of Otolaryngology – Head and Neck Surgery.

“Myringoplasty using the HAFGM technique reduces waiting times, cost of the procedure and time lost by parents and children,” said lead author Issam Saliba, MD, who developed the technique. “Regardless of the size of the perforation, the results are as good as those obtained using traditional techniques, with the incomparable advantage that patients don’t have to lose an entire working day, or 10 days or more.”

Myringoplasty surgery usually takes about 1-2 hours, and involves taking a layer of scalp fascia graft, usually from behind the ear in the hairline. This graft is then slipped behind the eardrum to cover the perforation. There are two approaches to the eardrum; one is through the ear canal (endaural approach), while the other uses an incision behind the ear and flipping it forward (post-auricular approach). The approach is decided upon depending on the site, the type of eardrum perforation, the reason for the surgery, and surgeon preference.

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Sainte-Justine University Hospital Center