There are many different surgical techniques to repair a perforation (hole) in the eardrum. The technique is tailored to the patient and to the size and position of the perforation.
The most common technique is a transcanal (operating down the ear canal using a speculum without any incision behind the ear) cartilage tympanoplasty. Cartilage is obtained from the tragus and placed within the perforation supported by dissolvable gelfoam in the middle ear.
Some large perforations can only be successfully accessed through an incision behind the ear. A graft of fascia may be taken from the temporalis muscle. The eardrum is lifted and the graft can be placed via an underlay technique. There is also the option of using a cartilage graft in this situation. Onlay techniques may also be used if there is a total or near total tympanic membrane perforation.
If the small bones of hearing (ossicles) are not functioning properly, then a titanium implant may be required to reconstruct the hearing mechanism at the time of tympanoplasty or later in a staged procedure after the tympanic membrane has healed.