Cartilage Tympanoplasty: What You Need to Know

What the Operation Is

This is an operation to repair a hole in your eardrum (the thin membrane inside your ear that vibrates when sound hits it). We use cartilage — the firm but bendy tissue from your ear — as a patch. Think of it as patching a punctured tyre: we close the hole so your eardrum can work properly again.

The cartilage is harvested from the visible part of your ear (the tragus or the conchal bowl), shaped to fit, and placed against the inside of the perforation. The lining of the ear canal heals over the graft over several months, sealing the perforation. Cartilage is used in preference to softer materials (such as temporalis fascia) when there is a higher risk of graft failure — for example in large perforations, recurrent perforations, or where there has been a history of Eustachian tube dysfunction.

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Risks & Complications

Scarring

• There may be a small scar either behind your ear or behind the tragus (the small flap of cartilage just in front of your ear canal).
• With any scar, there is a small chance it could become hypertrophic (pronounced "hy-per-TRO-fik") — meaning red, raised and inflamed along the line of the cut.
• Even rarer is a keloid scar (pronounced "KEE-loid"). This is similar to a hypertrophic scar but spreads beyond the original cut, creating a larger raised area.
• So far none of my patients have developed a hypertrophic or keloid scar from this operation.
• In most cases, I can perform the operation with no external scar at all — all the work is done inside your ear.

Bleeding after surgery

• There is a risk of some bleeding from the ear after the operation. This is usually minor and stops quickly.
• If it happens, we treat it by placing cotton wool gently in the ear; the bleeding typically settles within a short time.

Facial nerve damage

• The facial nerve is a very important nerve that runs through your ear and controls the muscles in your face.
• If this nerve were damaged during surgery (which is extremely rare), one side of your face would no longer be able to move — similar to what happens with a stroke. You would be unable to smile, close your eye, or move your eyebrow on that side.
• This damage could be permanent.
• I take extreme care during surgery to avoid this nerve. It is important you understand the risk exists. So far this has never happened to any of my patients in over 20 years of doing these operations.

Hearing loss and tinnitus

• Damage to the hearing apparatus — the eardrum, the three tiny bones (ossicles), or the cochlea where sound becomes nerve signals — can lead to hearing loss.
• The same damage may cause tinnitus: perceiving sounds that are not actually there. Patients describe ringing, buzzing, hissing, humming, a constant high-pitched tone, crickets chirping, or waves crashing.
• See also our tinnitus page if you would like to read about tinnitus in detail.

The ribbon gauze packing

• After the operation, I will place rolled-up ribbon gauze (a special medical fabric) inside your ear canal. This stays there for about three weeks to support the healing eardrum.
• This packing can only be safely removed by me at your follow-up appointment. Do not try to remove it yourself.
• If a small piece starts to come out (perhaps while sleeping or washing), don't panic. Contact my team and I will snip off the loose end with scissors at your next visit.
• Very important: do not push it back in or try to pull it out. Doing so could damage the delicate reconstruction inside your ear and undo all the repairs.

Hearing recovery takes time

• Your hearing will take several months to return to normal. This is completely expected — the ear needs time to heal properly.
• Be patient. Don't expect immediate results.
• Sometimes the perforation is not fully repaired during the first operation. In these cases, you might need a second operation a few months later.

No flying after surgery

• You are not allowed to fly for about three months after the operation.
• If you develop an infection during recovery, this "no flying" period may be extended further.
• Do not book any flights or travel plans until I have given you the all-clear. Changes in air pressure during flight could seriously damage your healing eardrum and completely undo the repair.
• This includes holidays abroad, work trips, or any reason to fly. It is not worth the risk.

Anaesthetic risks

Standard general-anaesthetic risks apply, which the anaesthetist will discuss separately.

Aftercare

• Keep the ear dry. No water in the ear for at least three months, and follow my specific advice afterwards.
• Painkillers — paracetamol is usually sufficient.
• Avoid heavy lifting, nose blowing, and straining for at least two weeks (pressure changes can dislodge the graft).
• Time off work: typically one to two weeks.
• Follow-up at three weeks for packing removal, then again at three and six months to check the graft has taken.

When to Call the Hospital or Attend A&E

• Sudden hearing loss in the operated ear.
• Severe vertigo or persistent dizziness.
• Persistent facial weakness or asymmetry — call urgently.
• Heavy bleeding or persistent discharge.
• Severe pain not relieved by simple painkillers.

Booking, Consent and Next Steps

If you are considering cartilage tympanoplasty, the secretarial team can arrange a consultation. See also Ear Drum Perforation, Hearing Loss, and Stapedectomy Consent.