Chronic Ear Surgery

Tympanoplasty
Mastoidectomy



PURPOSE:

This web page is an attempt to help patients and families to understand the basic principles of chronic ear surgery. It is not meant to be all-inclusive, nor is it any form of guarantee. It is not meant to be a substitute for personal attention to your problems and questions.

ANATOMY:

The ear is divided into three parts. The outer ear is composed of the auricle and the ear canal. The middle ear is the space inside the tympanic membrane (eardrum) and includes the eustachian tube. The ossicles (ear bones) are in the middle ear. The first bone is the malleus. The second is the incus. The third and smallest is the stapes. The inner ear is housed in the bone just inside the middle ear. This where the nerve endings of hearing and balance are located. The mastoid is the bone behind the ear. The brain lies above the middle and inner ear.

INDICATIONS FOR CHRONIC EAR SURGERY:

The two most common reasons for chronic ear surgery are chronic otitis media and cholesteatoma. Chronic otitis media is infection of the middle ear caused by a hole or perforation in the tympanic membrane (eardrum). This perforation (hole) is usually the result of previous infections or trauma. Cholesteatoma is a ball or sac of skin and debris which has grown into the middle ear and/or mastoid bone. Cholesteatoma destroys bone covering and important structures. Both chronic otitis media and cholesteatoma frequently cause chronic infection and drainage as well as hearing loss. The biggest risk of untreated ear infections is the risk of infection spreading to brain, lining of the brain, inner ear of hearing and/or balance, and the facial nerve.

Tympanoplasty is the repair of the perforation, usually with a graft or patch that is taken from the fibrous tissue behind the ear. Through an incision made behind the ear, the graft is placed under the eardrum to patch the hole.

A mastoidectomy is the removal of part of the mastoid bone which is behind the middle ear. It may be combined with a tympanoplasty. A mastoidectomy is done when infection or cholesteatoma is into the mastoid bone. If the ear canal is joined with the mastoid area, this creates a mastoid cavity which will have to be periodically cleaned. To ease this cleaning, sometimes the opening of the outer ear is enlarged.

Sometimes a revision or another correction may be advisable after the first operation. When possible, an attempt is made to remove all the disease, create a new eardrum, and improve hearing all in one operation. If this is not possible at the initial operation, a second procedure may be advised six to nine months later, or sooner if possible.




GOALS OF CHRONIC EAR SURGERY:

1) A safe ear (removal of the cholesteatoma and infection).
2) A dry ear, free of drainage, odor, and infection.
3) Improved hearing (not always possible).


WHAT WILL BE DONE IN THE OFFICE:

1) Examination by the doctor.
2) Audiogram (hearing test) by the audiologist.
3) An appraisal of the extent of the problem.
4) Discussion of treatment options, risks, and rationale.

RISKS:

The risks of chronic ear surgery are generally the same as the risks of letting the problem go untreated. The frequency of developing one of the complications is less with surgery than neglecting the ear condition. Some of the risks are: hearing loss, dizziness, meningitis, brain abscess, facial paralysis, tinnitus/ringing, failure of the graft, bleeding, infection, anesthetic complications.


WHAT TO EXPECT AT THE TIME OF SURGERY:

Surgery will be done as an outpatient. You may receive medications to use before surgery. Laboratory tests and x-rays may be done.

The surgery is usually done under general anesthesia (you will be asleep). The anesthesiologist is the specialist who will put you to sleep. An IV is usually started. Some of the hair around the ear may be shaved. The incision will be made behind the ear and/or in front of the ear. Sometimes the opening of the ear is made larger.

After surgery, there will be a large bandage or dressing covering the ear. The purpose is to reduce swelling and bleeding. The oozing which may be present should not cause alarm. There will be medications available for pain. The dressing may be removed from the outside of the ear the next day. Do not remove any gauze packing from down in the ear. A cotton ball may be placed in the outer ear to soak up any oozing for the first 24 to 48 hours only.

Outpatients are allowed to go home the same day of surgery. We ask that you not drive or operate equipment for 24 hours after general anesthesia. Prescriptions for medications you will need will be given to you after your surgery. Uusally, the sutures used to close the wound do not need to be removed.


WHAT TO EXPECT AT HOME:

The doctor will tell you when to return to the office at the time of your surgery. Most patients are able to return to work one week after the surgery.


DO'S AND DON'Ts:

1) Keep water out of your ear. Use a cotton ball coated with Vaseline in the outer ear when washing your hair or bathing
unless instructed otherwise by me.
2) DO NOT blow your nose for three weeks. Sniff back to clear your nose if needed.
3) For three weeks after surgery, open your mouth if you have to sneeze.
4) DO NOT remove anything from or place anything into your ear unless specificially instructed by Dr. Woods only!
5) Report to me if you have any of the following:
- Significant increase in pain.
- Increased swelling , redness, or draining pus.
- Persistent dizziness and nausea.
-Temperature consisently over 100 degrees.
-Any other unexpected or worrisome symptoms.
6) DO NOT expect immediate improvement of your hearing.
7) DO NOT hesitate to talk with the office nurse if you have a problem.