a. Injection

b. Irrigating Ear Canal

c. Defect Identification

d. Canal Injection

1. Approach and Exposure

2. Vascular Strip

3. Postauricular Incision

4. Canal Exposure

a. Cartilage Shaping

5. Cartilage Harvest

6. Canal Reconstruction

7. Tympanic Membrane Reconstruction

8. Closure

The tympanic membrane (ear drum) serves as a barrier between the middle and external ear, protecting the middle ear from infection. Additionally, the tympanic membrane is critical for hearing by providing impedance-matching between the air of the external canal and the fluid of the inner ear. When the membrane is disrupted, patients may experience hearing loss, recurrent infections, and ear drainage. Etiologies of perforations include infection and trauma. When perforations persist and cause symptomatic hearing loss or recurrent infections, they can be surgically repaired by an otolaryngologist. Although the success rates for primary tympanoplasty are high (75–95%), failures can make future attempts at repair more challenging. In this case, a 61-year-old female had undergone two prior tympanoplasties without success. Dr. Cunningham demonstrates intraoperative decision-making as well as the surgical approach and techniques for repair in these difficult cases.

Duke University Medical Center