If the eardrum does not heal on it’s own, and the perforation is small, it can sometimes be closed by a simple office procedure. The ear surgeon can anesthetize the edges of the eardrum with a strong solution of Xylocaine or Phenol, or inject the ear canal skin with Xylocaine. Xylocaine will anesthetize on contact. Once the eardrum is anesthetized, the undersurface can be scratched with a sharp right angled hook. This stimulates the undersurface skin to heal and, in some instances, the drum will close. At the same time, the ear surgeon places a patch made of cigarette-type paper or other thin substance onto the outer surface of the eardrum. This will provide a matrix to allow the skin to heal underneath the drum. Perforations do not always heal with these techniques. Thus, in some cases, microsurgery may be necessary to close the perforation. This surgery is called tympanoplasty. It is often done on an ambulatory basis, going home on the same day of surgery.