Every year, thousands of patients require surgery to repair a perforated eardrum.
A new keyhole procedure avoids scarring and post-op pain — and recovery time is faster.
Patricia Duncan, 59, a nurse from Lanarkshire, had the treatment, as she tells OONA MASHTA.
THE PATIENT
Ever since I can remember, I haven’t been able to hear anything in my right ear.
As I was growing up, my mother explained to me that it was because I’d had a very bad ear infection when I was six years old which had led to a perforated eardrum.
I remember the intense pain as my eardrum perforated, but no other details.
Patricia Duncan, a nurse from Lanarkshire, is one of the first patients in the UK to have the op
The doctor told my mother the eardrum was likely to heal by itself and my hearing would improve, but it never did.
Over the years, I learnt how to manage; I never even thought of going to the doctor’s for treatment, I just relied on my left ear.
I put the receiver to that ear when answering the phone and automatically pointed my left side towards people to hear them speak.
The major problem was if water got into my right ear, it caused me excruciating pain and I’d feel dizzy because it affected my balance (it disturbed my middle ear, which controls this).
I used to plug my ears with cotton wool when I showered, washed my hair or went to the hairdressers, and somehow got by.
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I only did something about my lack of hearing when I started suffering from age-related hearing loss in my ‘good’ ear in my 40s.
My husband, Tom, often complained the TV was too loud and friends would ask why I was shouting. It became really difficult to work.
In January 2015, I went to see my GP and he referred me to Wishaw General Hospital in Lanarkshire for tests.
Two weeks later I was there having a hearing test — the consultant then told me my right eardrum was 95 per cent damaged. I was shocked, as this was the first time I realised how bad it was.
After a hearing test, Patricia Duncan was told that her right eardrum had been 95 per cent damaged
He suggested I could have surgery to make a graft from the skin near my ear and put it in place of the eardrum — or I could wear hearing aids.
I chose the hearing aids because they were less invasive.
But then I had a hearing test which I failed disastrously. I was upset because I faced surgery, which I thought would be risky.
I was referred to an ear, nose and throat surgeon, Arun Iyer, who offered me a new keyhole procedure. It was less invasive because they’d also take a graft from inside my ear, so I wouldn’t be left with a scar.
I immediately agreed and had the procedure in January this year under general anaesthetic.
All I can remember is waking up after the operation with a bandage around my head and my right ear plugged up — I wasn’t in any pain, which surprised me.
On my way home later that day, I was shocked because I could hear people talking on my right side.
Patricia has been unable to hear through her right ear for more than 50 years, and says having her hearing restored was ‘strange but absolutely wonderful’
It must have been the first time I could hear through my right ear for more than 50 years. It was strange but absolutely wonderful.
Though I have a little age-related hearing loss in my left ear, my hearing in my right is so good I don’t really notice any more.
Life is so much easier and wherever I stand, I can hear.
THE SURGEON
Arun Iyer is a consultant ear, nose and throat surgeon at Monklands Hospital in Lanarkshire. He says:
The eardrum is a thin layer of tissue separating the outer ear from the middle ear — a perforated eardrum is literally a hole or tear in it.’
Normally sound waves enter the outer ear and hit the eardrum, causing it to vibrate.
Behind the eardrum there are three tiny bones. The vibrations pass from the eardrum to these bones in the middle ear.
With a perfect eardrum, the sound energy going in is magnified by 17 times so we can hear clearly. Perforated eardrums can cause pain if water gets in
The bones then transmit the vibrations to the cochlea in the inner ear, which converts the vibrations to electrical signals that are transmitted to the brain which we then hear.
The eardrum also prevents ear infections by protecting the middle ear.
With a perfect eardrum, the sound energy going in is magnified by 17 times so we can hear clearly.
With a perforated eardrum the sound waves are not transmitted efficiently or amplified — the bigger the perforation, the less you can hear.
Ear infections are the most common cause of eardrum perforations: they increase pressure in the middle ear so the eardrum is vulnerable to burst.
Other causes include long-standing glue ear (where fluid collects in the middle ear and cannot drain away) and trauma.
Perforated eardrums can cause pain if water gets in because the middle ear is lined with sensitive cells.
Normally sound waves enter the outer ear and hit the eardrum, causing it to vibrate. Behind the eardrum there are three tiny bones
The ear is also prone to recurrent infections because there is no longer a barrier to stop bacteria getting in.
Small perforations often heal spontaneously. But after two years they are unlikely to heal without treatment.
Larger perforations need surgery because there is too much damage and the body can’t regenerate enough tissue to repair it.
Traditional surgery involves cutting a 3-4cm piece of tissue either from the front or behind the ear and using it as a graft to repair the hole.
This is usually done by inserting it through another incision in the back of the ear. It can take between one and four hours, depending on the patient.
Recovery is slow as patients usually suffer from pain for about three weeks, and the incisions can leave scars.
Patients usually have to wear a head bandage for a day and have dressing material inside their ear for up to three weeks, so they won’t be able to hear immediately.
Surgeons often use endoscopes to look into the ear during traditional surgery, but at an international conference Dr Arun Iyter discovered a new method
Many patients experience pain when eating because the muscle that helps us chew, the temporalis, is swollen after surgery too.
I have been using endoscopes (long tubes with a camera on the end) to look into the ear during traditional surgery for a long time, but in 2013 at an international conference I learnt how to use them to conduct this eardrum perforation repair, taking a graft from inside the ear.
WHAT ARE THE RISKS?
As with any ear surgery, there is a small chance of hearing loss due to damage while operating.
Taste disturbance, because the taste nerve travels via the ear drum and can therefore be stretched and, very rarely, cut.
As with any ear surgery, there is a small chance of hearing loss due to damage while operating
Dizziness — but usually only short term.
Mr Jeremy Lavy, a consultant ear surgeon at the Royal National Throat, Nose and Ear Hospital in London says: ‘Endoscopic ear surgery is becoming more widespread in the UK as it is helpful in situations when it is difficult to see the part of the ear surgeons need to work on.
‘It is another useful tool in ear surgery, like the microscope. But it is unlikely that the endoscope will ever completely take over from open ear surgery.’
Endoscopic ear surgery prevents the need for an incision in the skin, resulting in less pain.
With the patient under a general anaesthetic, I insert the endoscope via the ear canal itself and watch where I am going on a screen.
Once I reach the eardrum, I ‘lift’ it then cut a small graft from the lining of cartilage inside the ear, just in front of the ear canal.
This graft is then used to patch the eardrum in the usual way.
Taking the graft here causes much less pain because the incision is much smaller, and so the recovery time is much shorter.
Patients can often go home the same day and can hear almost immediately as the ear doesn’t need to be packed with dressing.
They may be able to go back to work within a week, whereas patients who have had open surgery who will need around three weeks off.
The eardrum healing rates and hearing improvement rates are the same, and if the perforation doesn’t heal enough we can repeat the surgery.
I am now teaching other surgeons — currently the procedure is only available at a few centres in Birmingham, Bolton and Lanarkshire.
Endoscopic ear surgery costs £3,000 both to the NHS and privately.