{{Short description|Surgical operation in the ear}} {{Infobox medical intervention | name = Myringoplasty | synonym = | image = | caption = | alt = | pronounce = | specialty = Otorhinolaryngology
| synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }} '''Myringoplasty''' is the closure of the perforation of pars tensa of the [[tympanic membrane]].<ref name=glennwatson>{{cite web|last=Watson|first=Glenn|title=Myringoplasty repairs a hole in the tympanic membrane|url=http://www.glennwatson.com.au/Myringoplasty.html|publisher=Glenn Watson Pty|accessdate=13 August 2012|archive-url=https://web.archive.org/web/20121221014726/http://www.glennwatson.com.au/Myringoplasty.html|archive-date=21 December 2012|url-status=dead|df=dmy-all}}</ref><ref name=entsurgeon>{{cite web|title=Operations and Procedures: Myringoplasty|url=http://www.ent-surgeon.co.uk/operations/myringoplasty.htm|publisher=ENT Surgeon|accessdate=13 August 2012|archive-url=https://web.archive.org/web/20120110134546/http://www.ent-surgeon.co.uk/operations/myringoplasty.htm|archive-date=10 January 2012|url-status=dead|df=dmy-all}}</ref><ref name="Rozendorn 2016">{{Cite journal|last=Rozendorn|first=Noa|last2=Wolf|first2=Michael|last3=Yakirevich|first3=Arkadi|last4=Shapira|first4=Yisgav|last5=Carmel|first5=Eldar|date=November 2016|title=Myringoplasty in children|journal=International Journal of Pediatric Otorhinolaryngology|volume=90|pages=245–250|doi=10.1016/j.ijporl.2016.09.024|pmid=27729143|issn=0165-5876}}</ref> When myringoplasty is combined with removal of scar tissue, it is called [[tympanoplasty]]. The operation is performed with the patient supine and face turned to one side. The graft material most commonly used for the surgery is temporalis fascia. The tragal cartilage<ref name=glennwatson /> and tragal perichondrium are also used as the graft by some surgeons.
Myringoplasty restores hearing loss in certain cases of [[tinnitus]]. The chances of re-infection and persistent discharge is less after surgery. Myringoplasty should not be performed if there is active discharge from the [[middle ear]], or if the patient has uncontrolled nasal allergy, or when the other ear is dead and in children less than 3 years of age. Myringoplasty is often done under [[general anaesthesia]], but it can be done under local anaesthesia also.
==Technique of surgery==
===Underlay technique=== The [[temporalis fascia]] is grafted. An incision is made along the edge of the perforation and a ring of epithelium is removed. A strip of mucosal layer is removed from the inner side of the perforation. The middle ear is packed with [[gelfoam]] soaked with an [[antibiotic]].<ref name=entsurgeon /> The edges of the graft should extend under the margins of the perforation and a small part should also extend over the posterior canal wall. The tympanomeatal flap is then replaced.{{cn|date=February 2022}}
===Overlay technique=== The temporal fascia is harvested. An incision is made to raise medial meatal skin with [[tympanic membrane]] epithelium. The graft is placed on the outer surface of the tympanic membrane and a slit is made to tuck it under the handle of the [[malleus]]. The ear is packed with gelfoam and antibiotics,<ref name=entsurgeon /> and the incision is closed. Finally [[mastoid dressing]] is performed.
==Advantages== * Restores the hearing loss and in some cases, [[tinnitus]]. * Checks the re-infection from external auditory canal and [[eustachian tube]]. * Checks [[allergen|aeroallergens]] reaching the exposed middle ear mucosa, leading to persistent ear discharge.
==Contraindications== * Active discharge from the middle ear * Nasal allergy, which should be controlled before surgery * When the other ear is dead or not suitable for hearing * [[Otitis externa]] * Children below 3 years
==See also== *[[Tympanoplasty]] *[[Myringotomy]]
==References== {{reflist|2}}
[[Category:Ear surgery]]