How is a Hole in the Eardrum Repaired?

After a decision has been made to repair 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.

SO... here's what a normal ear looks like (image 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 how they are corrected here.

Why Does the Nose Whistle in Some People?

Though most people like the professional nose whistler shown here require an instrument to enable the nose to whistle, in others it occurs naturally due to unique anatomic features within the nose.

Why might someone's nose whistle?

Septal Perforation

The most common reason it may occur constantly is due to a hole in the septum (septal perforation). The septum is a wall that divides the right nasal cavity from the left side. Normally, it should be straight and without any openings.

However, when a hole is present in the septum and it is in just the right size and place, whenever air is breathed in and out the nose, it will whistle. In this situation, the hole is the "window" of the whistle and the nose itself is the mouthpiece.

Correction of this problem is by either closing the hole (septal button or surgery) or making it bigger such that the aerodynamics eliminate the conditions conducive to nasal whistling. As an FYI, surgical correction of a septal perforation is quite difficult.

Septal Deviation and Some Nasal Congestion

The other situation when the nose may whistle, but only intermittently, is when there is a deviated septum. In this scenario, the septum rather than being straight, it is slightly crooked to one side making one side more narrow than the other.

Add some slight swelling of the nasal lining such that the opening of the nose is restricted to just right size and shape, and it may whistle.

This type of nasal whistling is akin to grass whistling (blowing between two thumbs holding a blade of grass).

Thankfully, the nasal conditions that lead to nasal whistling is quite rare and requires the perfect storm of just the right amount of septal deviation with just the right amount of nasal congestion.

As such, correction of this problem is fairly easy as one needs to change either the congestion causing the nasal lining to swell with a nasal spray or anti-histamine OR fix the deviated septum. If the inferior turbinates are enlarged, they can be reduced in size as well.

Of course, one can take this unusual condition and make it a positive feature worthy of a concert hall... WITHOUT the assistance of any instrument!

New Webpage on the Perforated Eardrum

A perforated (or hole) eardrum is a common condition many patients have when presenting to their ENT doctor. Given how common this problem is, a new webpage has been created that describes this condition as well as how it is managed/treated. Click here to read more.