How is a Hole in the Eardrum Repaired?

If a hole in the eardrum does not heal closed and a decision has been made to pursue repairing a hole in the eardrum (also known as tympanic membrane perforation), it is not uncommon for patients to get confused among the different surgical techniques used to fix it.

There are 3 major "flavors" of eardrum hole repair. 

• Paper patch: Paper patch technique involves putting a thin membrane (film paper, gelfoam, etc) OVER the eardrum hole.
• Medial or Underlay Tympanoplasty: In the underlay technique (also known as medial tympanoplasty), patient's own tissue (temporalis fascia) is used as a graft to reconstruct the eardrum by laying it UNDER the eardrum and ear canal wall skin.
• Lateral or Overlay Tympanoplasty: In the overlay technique (also known as lateral tympanoplasty), patient's own tissue (temporalis fascia) is used as a graft to reconstruct the eardrum by laying it OVER the eardrum extending from placement UNDER the ear canal wall skin.

Technically, the paper patch is easiest to perform and the overlay tympanoplasty the most technically difficult to perform.

There is a fourth type you can read about here.

SO... here's what a normal ear looks like (image by Chittka and Brockmann modified from Wikipedia):

Here's a hole in the eardrum:

Paper patch technique (graft shown as a purple strip). Note the paper patch is laying OVER the ear canal skin and eardrum.

Medial or Underlay Tympanoplasty: Note the graft is laying UNDER the ear canal skin and eardrum.

Lateral or Overlay Tympanoplasty: Note the graft is laying UNDER the ear canal skin and OVER the eardrum.

Read more about eardrum holes and a fourth type of repair here.

The first video shows actual surgical footage. The second is just animation.