Specialties · Otologic surgery
Ear surgery: when it is indicated and how it works
Ear surgery covers procedures that reconstruct the eardrum, treat middle ear disease or repair the hearing mechanism. The best known is tympanoplasty, which closes a perforated eardrum. The indication depends on what the tests show and on the impact on the patient's life, and is never automatic.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What does ear surgery address?
The term “ear surgery” covers procedures that differ considerably from one another. The most frequent have three purposes:
- Closing the eardrum. Tympanoplasty reconstructs the perforated membrane with a graft from the patient, restoring the barrier between the ear canal and the middle ear.
- Removing disease. Tympanomastoidectomy clears the middle ear and the mastoid, the bone behind the ear, where there is cholesteatoma or infection that will not settle.
- Restoring sound transmission. Ossiculoplasty reconstructs or replaces the hearing bones when disease has damaged them.
In children there is also placement of a ventilation tube, or grommet — a short procedure that drains fluid trapped behind the eardrum.
Where hearing loss is severe to profound and none of these procedures can address it, the path is a cochlear implant, which has its own page.
When is surgery indicated?
The indication usually arises in one of these situations:
- A perforated eardrum that has not healed after months.
- An ear that discharges repeatedly, despite well-conducted medical treatment.
- Conductive hearing loss with an impact on daily life.
- Cholesteatoma, confirmed or suspected — here surgery is the treatment, not one option among others.
How is the pre-operative assessment done?
| Step | What it is for |
|---|---|
| Consultation and otoscopy | To see the eardrum, and the size and position of the perforation |
| Audiometry | To measure the degree of loss and separate conductive from sensorineural |
| Tympanometry | To assess pressure and mobility of the eardrum–ossicular system |
| CT of the temporal bones | To see the bone, the ossicles and the extent of disease |
| Pre-operative medical assessment | To check general fitness for anaesthesia |
The surgical plan emerges from this whole picture. Two patients whose notes both read “perforated eardrum” may receive entirely different recommendations.
What does recovery usually involve?
Recovery varies with the extent of the procedure, but some points are common:
- Keeping the ear dry until cleared by the surgeon.
- Not blowing the nose forcefully — pressure travels up the Eustachian tube and reaches the graft.
- Avoiding strenuous exercise, diving and air travel during the advised period.
- A blocked sensation and muffled hearing in the first weeks is expected, because there is an internal dressing in the canal.
- Outpatient follow-up visits for cleaning and monitoring of healing.
Hearing outcome is only assessed after healing is complete, with a fresh audiogram.
Follow-up at Clínica Rhinus
Assessment, hearing tests and pre- and post-operative follow-up take place at the clinic, in the Renascença district of São Luís. Hearing tests are performed by the speech-language pathologists on our team. Surgery is carried out in a hospital setting.
Prof. Aline Bittencourt completed a fellowship in advanced otologic and lateral skull base surgery and a PhD in otorhinolaryngology at the University of São Paulo (USP), and is a member of the Brazilian Society of Otology.
Sources: Brazilian Society of Otology · Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Tratado de Implante Coclear e Próteses Auditivas Implantáveis. 2nd ed. Thieme Revinter. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about otologic surgery
What is a tympanoplasty?
It is surgery to reconstruct a perforated eardrum, using tissue from the patient — usually the fascia of a muscle or cartilage from the ear — as a graft. When the procedure also includes reconstruction of the hearing bones, it is called tympanoplasty with ossiculoplasty.
Does every perforated eardrum need surgery?
No. Small, recent perforations, such as those following acute otitis or trauma, often heal on their own within weeks. Surgery is considered when the perforation persists, when the ear discharges frequently, or when hearing loss is troublesome.
Is the surgery done under general anaesthesia?
In most cases yes, although there are situations where local anaesthesia with sedation is possible. The decision rests with the anaesthetist together with the surgeon, considering the extent of the procedure and the patient's general health.
What does recovery usually involve?
The early period calls for relative rest, keeping the ear dry, and avoiding forceful nose-blowing and physical exertion. Dressings and any stitches are removed at a follow-up visit. Return to activities varies with the type of surgery and with each person, and is advised individually.
Does hearing improve after surgery?
It depends on what caused the loss. If it stems from the perforation or from the ossicles, there is room for improvement. If the cochlea, the sensory organ, is also affected, surgery does not correct that component. This is why pre-operative audiometry is essential: it shows what can reasonably be expected.
Talk to our team about your case
Every surgical indication is assessed individually. Book a consultation and bring your audiometry, CT scan and any referral from another service. It is with those results in front of us, alongside your history, that the plan takes shape.