What is the Eavey technique? Exploring the innovative approach to eardrum repair

September 30, 2025 •

4 min read

With reported success rates ranging from 90-100% in many studies, the Eavey technique stands out as a highly effective method for repairing eardrum perforations. This surgical approach, also known as inlay butterfly cartilage tympanoplasty, offers a less invasive alternative to traditional eardrum repair, promising quicker recovery and increased patient comfort.

Quick Summary

The Eavey technique, or inlay butterfly cartilage tympanoplasty, is a minimally invasive surgical procedure to repair eardrum perforations. It utilizes a butterfly-shaped cartilage graft inserted through the ear canal, avoiding extensive incisions and ear canal packing, resulting in faster recovery and better patient comfort.

Key Points

Minimally Invasive: The Eavey technique is a minimally invasive surgery performed through the ear canal, avoiding large incisions.
Butterfly Cartilage Graft: A specially shaped cartilage graft, resembling a butterfly, is harvested from the tragus and inlaid into the eardrum perforation.
Enhanced Stability: The rigid cartilage and unique shape of the graft provide instant stability and support for the healing tympanic membrane.
Faster Recovery: Patients typically experience a quicker recovery time and less discomfort compared to traditional tympanoplasty methods.
No Ear Packing: The technique does not require ear canal packing, which is a significant advantage for patient comfort and immediate post-operative hearing.
High Success Rates: The procedure has demonstrated high success rates for graft healing and closure in studies involving appropriate candidates.
Suitable for Central Perforations: It is primarily used for small to medium-sized central perforations of the eardrum.

What is the Eavey Technique? A Surgical Overview

Developed by Dr. Roland Eavey in 1998, the Eavey technique is an innovative method for repairing central perforations of the tympanic membrane (eardrum). It is formally known as inlay butterfly cartilage tympanoplasty due to the shape of the graft used during the procedure. The technique is a minimally invasive option for many patients and differs significantly from older methods that often require more extensive surgical steps, longer operating times, and a lengthier recovery.

The central innovation lies in the use of a composite graft made from cartilage and perichondrium, typically harvested from the tragus (the small flap of cartilage at the front of the ear). This specially shaped graft is then 'inlaid,' or inserted directly into the perforation, without the need for elevating a tympanomeatal flap or placing ear canal packing. The natural rigidity of the cartilage and the unique 'butterfly' shape, with one flange on each side of the eardrum, provides excellent stability. This inherent stability is a key factor in the technique's success and contributes to a more comfortable post-operative experience.

The Eavey Technique Procedure: A Step-by-Step Guide

The Eavey technique is performed via a transcanal approach, meaning the surgeon accesses the eardrum directly through the ear canal, often with an endoscope or microscope. The procedure can be carried out under local anesthesia in many adult cases, adding to its convenience and lower morbidity.

Here are the general steps involved:

Preparation and Harvesting: The surgeon first prepares the area and harvests a small piece of cartilage and attached perichondrium from the tragus. The incision required for harvesting is very small and discreet.
Graft Shaping: The harvested cartilage is carefully shaped into a "butterfly" or "button" configuration, with a circumferential groove created to fit snugly into the edges of the perforation.
Perforation Freshening: The edges of the eardrum perforation are trimmed or freshened to promote healing and graft integration.
Graft Insertion: Using an endoscope or microscope, the surgeon inserts the butterfly graft through the ear canal, fitting its grooved center into the perforation. The flanges of the graft rest on either side of the eardrum, locking it into place.
Closure: The small incision used to harvest the cartilage is closed with simple sutures, and no extensive ear canal packing is needed.

Benefits of Choosing the Eavey Technique

For eligible patients, the Eavey technique provides significant advantages over older surgical methods for tympanoplasty. These benefits are centered on reducing invasiveness, shortening recovery, and improving patient comfort.

Reduced Operative and Recovery Time

The entire procedure is often quicker to perform, with some studies reporting significantly shorter operative times compared to underlay techniques.
The absence of ear canal packing means there is no need for a follow-up office visit for removal, and immediate hearing after surgery is typically better.

Enhanced Patient Comfort

Because no packing is required, patients do not experience the discomfort or feeling of fullness in the ear that is common with other procedures.
The recovery period is often less painful, and patients can resume normal activities more quickly.

High Efficacy and Reduced Morbidity

Studies have shown high success rates for graft integration and closure, on par with or sometimes surpassing traditional methods for appropriate candidates.
The procedure is associated with low overall morbidity, meaning fewer complications related to the surgery itself.
Based on information from a study published in the Journal of Laryngology and Otology, the transcanal approach avoids periauricular skin incisions that can cause increased post-operative issues.

Comparison Table: Eavey vs. Traditional Tympanoplasty


Feature	Eavey Technique	Traditional Tympanoplasty (Underlay/Overlay)
Invasiveness	Minimally invasive; transcanal approach	More invasive; may require postauricular incision for access
Incision	Small, discreet tragal incision for graft harvesting	Larger incisions often made behind the ear or in the ear canal
Anesthesia	Local anesthesia often sufficient for adults	Typically requires general anesthesia
Ear Packing	No packing of the ear canal required	Often requires packing of the external ear canal
Recovery Time	Faster return to daily activities; minimal downtime	Longer recovery period, especially if a postauricular incision is made
Patient Comfort	Higher comfort post-operatively; less pain and feeling of fullness	Potentially more discomfort due to packing and incisions
Cost-Effectiveness	Generally a lower-cost procedure due to shorter operative time	Can be more expensive due to longer operating and recovery room times

Candidate Eligibility for the Eavey Technique

While the Eavey technique offers many benefits, it is not suitable for every type of tympanic membrane perforation. Candidates are typically those with small to medium-sized central perforations. In some cases, modified versions of the technique can be used for larger perforations. The patient's overall ear health, including any existing middle ear disease or hearing loss, is also a consideration. An otolaryngologist can perform a detailed evaluation to determine if the Eavey technique is the best option.

Conclusion: A Modern Advancement in Eardrum Repair

The Eavey technique represents a significant advancement in the field of tympanoplasty, offering a less invasive and highly effective solution for repairing eardrum perforations. Its key features—the use of a simple yet robust cartilage graft, the transcanal approach, and the avoidance of extensive packing—result in a smoother experience for patients. For those with central, small-to-medium-sized perforations, the Eavey technique provides a proven path toward anatomical closure and improved hearing, with the added benefits of quicker recovery and reduced discomfort. As with any surgical procedure, prospective patients should discuss their individual case with a qualified specialist to ensure they are a suitable candidate and understand all potential outcomes.

Frequently Asked Questions

No, the Eavey technique is most suitable for small to medium-sized central perforations of the tympanic membrane. An otolaryngologist will determine your eligibility after a thorough evaluation.

Recovery is typically faster than with traditional tympanoplasty. Patients experience minimal downtime, and can often return to normal activities within a few days to a week. Full recovery takes longer, but the immediate post-operative period is much more comfortable.

Advantages include a minimally invasive transcanal approach, reduced operative time, faster and more comfortable recovery with no need for ear packing, and lower cost.

The goal of the procedure is to close the eardrum perforation and improve hearing by closing the air-bone gap. Studies have reported significant hearing improvement for many patients following a successful procedure.

For many adult patients, the Eavey technique can be performed under local anesthesia with sedation, though it can also be done under general anesthesia.

Potential complications are generally low but include risks such as graft failure (the perforation re-opens), minor discomfort, or infection. In the event of graft failure, a repeat procedure may be necessary.

A small piece of cartilage with its perichondrium is typically harvested from the tragus, the small cartilage flap at the entrance of the ear canal. The incision for this is minimal.

Yes, the Eavey technique was originally described for use in the pediatric population and is a viable, well-tolerated option for children with appropriate perforations.