A hole in the eardrum, and why it matters
The eardrum is a thin membrane that does two jobs: it transmits sound to the tiny bones of the middle ear, and it seals the middle ear off from the outside world. When it is perforated, both jobs are compromised.
Perforations follow chronic middle-ear infection in childhood, an untreated infection that burst through the drum, injury, or a blast or slap to the ear. Many people have lived with one for years, managing it with drops whenever discharge returns, without realising it can be repaired.
What patients typically describe
- Ear discharge that returns repeatedly, often after a cold or after water enters
- Reduced hearing on that side, sometimes worse during an episode of discharge
- Having to avoid swimming, or plug the ear carefully every bath
- An intermittently blocked feeling, or occasional pain
- Tinnitus in the affected ear
Beyond the inconvenience, an open perforation allows repeated infection of the middle ear, which over years can damage the hearing bones and, in some types of disease, cause more serious complications. Closing the drum is preventive as much as it is restorative.
Not every ear problem needs surgery
Small perforations following an injury frequently heal by themselves over weeks, and the right treatment then is to keep the ear dry and wait. Infections of the outer ear canal, wax obstruction and eustachian tube dysfunction all cause similar symptoms and are treated medically.
Surgery is considered when a perforation has failed to heal, when discharge keeps recurring, when hearing is affected, or when the type of disease present carries a risk of complications — particularly cholesteatoma, a skin-lined sac in the middle ear that expands and erodes bone, which always requires surgical treatment.
What assessment involves
- Examination under a microscope or endoscope — the size, position and type of perforation matter a great deal to the plan
- Pure-tone audiogram — measures the degree and type of hearing loss and whether the hearing bones are involved
- CT scan in selected cases, particularly where cholesteatoma or bone erosion is suspected
Record how hearing difficulty affects you
The Hearing Handicap Inventory records the day-to-day effect of hearing difficulty, which a hearing test alone does not capture. Your answers stay on your own device.
Open the questionnaire →What tympanoplasty involves
The principle is straightforward: the edges of the perforation are freshened, and a graft of the patient's own tissue — usually temporalis fascia from just above the ear, or cartilage from the ear itself — is placed to seal the hole. The body's own tissue then integrates and becomes a new drum.
The approach varies. Many perforations can be repaired endoscopically through the ear canal, with no external cut at all. Others need a small incision behind or in front of the ear, which heals into a scar hidden in the natural crease. Where the hearing bones are damaged or eroded, they can be reconstructed at the same operation — an ossiculoplasty — to restore the sound conduction mechanism.
Where cholesteatoma is present, the operation is more extensive, because all the disease must be removed to prevent recurrence and complications. Hearing reconstruction may then be staged as a second procedure.
Recovery
- First week: a dressing in the ear canal; hearing sounds muffled — this is the dressing, not the result of the surgery
- Weeks 2–3: dressings removed in clinic; back to routine work for most people
- Keep the ear completely dry for several weeks — no swimming, careful bathing, no water entry
- Avoid nose-blowing forcefully, straining and air travel in the early weeks as advised
- 6–12 weeks: the graft is stable, hearing is reassessed with a repeat audiogram
Results and risks
Successful closure of the eardrum is achieved in the large majority of cases — commonly quoted around 85 to 90 per cent, depending on the size and site of the perforation, the state of the middle ear and eustachian tube function. Hearing improves in many patients, though the primary aims are a dry, safe ear and freedom from repeated infection.
It is important to be realistic: hearing improvement depends on why the hearing was reduced. If the hearing bones are intact and the loss was due to the perforation alone, gains are usually good. If there is nerve-related (sensorineural) loss, closing the drum will not change that component.
Risks include graft failure requiring revision, infection, altered taste on one side of the tongue that usually settles, dizziness in the early days, tinnitus, and — uncommonly — worsening of hearing. These are discussed individually before surgery.
Sudden hearing loss in one ear (this is an emergency — treatment is time-sensitive), severe ear pain with fever, facial weakness, severe dizziness with vomiting, or foul-smelling discharge that keeps returning despite treatment.
ചെവി ശസ്ത്രക്രിയ — ചുരുക്കത്തിൽ
കർണ്ണപടലത്തിൽ (ചെവിയുടെ പടം) ദ്വാരമുണ്ടെങ്കിൽ ഇടയ്ക്കിടെ ചെവിയിൽ നിന്ന് വെള്ളം/പഴുപ്പ് വരിക, കേൾവി കുറയുക, വെള്ളം കയറാതെ സൂക്ഷിക്കേണ്ടി വരിക എന്നിവയുണ്ടാകും. നീന്താൻ കഴിയാത്തതും കുളിക്കുമ്പോൾ ചെവി അടച്ചുവയ്ക്കേണ്ടി വരുന്നതും സാധാരണ പരാതികളാണ്.
ടിംപനോപ്ലാസ്റ്റി: രോഗിയുടെ സ്വന്തം കോശം ഉപയോഗിച്ച് ഈ ദ്വാരം അടയ്ക്കുന്നു. മിക്ക കേസുകളിലും ദ്വാരം വിജയകരമായി അടയുന്നതായി പഠനങ്ങൾ പറയുന്നു; എന്നാൽ ഫലം ഓരോ രോഗിയിലും വ്യത്യാസപ്പെടാം. പല കേസുകളിലും ചെവിക്കുഴലിലൂടെ തന്നെ (എൻഡോസ്കോപ്പ് ഉപയോഗിച്ച്) ചെയ്യാം — പുറത്ത് മുറിവില്ല.
ശസ്ത്രക്രിയയ്ക്ക് ശേഷം: ഏതാനും ആഴ്ചകൾ ചെവിയിൽ വെള്ളം കയറാതെ സൂക്ഷിക്കണം. ആദ്യ ആഴ്ചയിൽ കേൾവി മങ്ങിയതായി തോന്നുന്നത് ഡ്രസിംഗ് കാരണമാണ്.
അടിയന്തരം: പെട്ടെന്നുള്ള കേൾവിനഷ്ടം ഉടൻ ചികിത്സ വേണ്ട അവസ്ഥയാണ് — കാത്തിരിക്കരുത്.
Frequently asked questions
Can a perforated eardrum be repaired?
Yes. Tympanoplasty repairs the eardrum using a graft of the patient's own tissue, usually fascia or cartilage, placed under a microscope or endoscope. Successful closure is achieved in approximately 85 to 90 per cent of cases. It stops recurrent discharge, removes the need for constant water precautions, and often improves hearing.
Will my hearing come back completely after eardrum surgery?
It depends on why hearing was reduced. If the loss was caused by the perforation alone and the hearing bones are intact, improvement is usually good. If the hearing bones are eroded they can often be reconstructed at the same operation. Nerve-related hearing loss, however, is not corrected by repairing the eardrum.
How long must I keep the ear dry after surgery?
Several weeks, as directed after your review. No swimming, and careful bathing with the ear protected. Water entering during healing is one of the commonest causes of graft failure, so this instruction matters more than patients often expect.
Is ear surgery done through a cut behind the ear?
Not always. Many perforations are now repaired endoscopically through the ear canal with no external incision. Larger or more complex disease may need a small incision in front of or behind the ear, which heals into a scar hidden in the natural skin crease.
What is cholesteatoma and why does it need surgery?
Cholesteatoma is a sac of skin trapped in the middle ear that gradually expands and erodes surrounding bone. It does not respond to medication and can lead to serious complications involving hearing, balance, the facial nerve and, rarely, structures inside the skull. Surgery to remove it completely is the only effective treatment.
What should I do about sudden hearing loss in one ear?
Treat it as an emergency and seek assessment the same day. Sudden sensorineural hearing loss responds best to treatment started within the first few days, and the chance of recovery falls significantly with delay. Do not wait to see whether it improves on its own.
Related information
This page is general health information about ear surgery and eardrum repair and is not a substitute for a personal medical consultation. Every patient is different; treatment decisions — including whether surgery is appropriate — should be made after an examination by a qualified ENT surgeon. If you have sudden severe symptoms such as difficulty breathing, heavy bleeding, sudden hearing loss or severe headache, seek emergency medical care immediately.