The tympanic membrane, or ear drum, is made of tissue similar to skin. In most cases, perforations of the ear drum by some type of trauma, such as a puncture by a cotton tipped applicator, or a slap injury, will heal spontaneously, in much the same way a cut on an arm would heal.
In some cases however, a perforation may persist. Perforations that result from infections, as when a tympanic membrane bursts, or when chronic infections have led to irreparable damage to the membrane itself, often do not heal.
When a tympanic membrane perforation persists, the middle ear is unprotected and is vulnerable to infection. When a perforation is present, the ear canal must be kept dry. Repair of the tympanic membrane perforation reinstates the protective barrier to the middle ear, and in some cases can also improve hearing.
Tympanoplasty is a microsurgical procedure that uses a patient's own tissues to reconstruct the tympanic membrane. The laser may be used to delicately remove scarring in the middle ear. This type of elective surgery is performed either through the ear canal alone or both through the ear canal and behind the ear. The success rate of this surgery is high, and potential risks of complications are low.