Ear Infections & Surgical Management
Chronic Ear Infections
The diagnosis of chronic otitis media (long standing infections of the middle ear) has been determined as the cause of your ear problem. This may cause drainage from your ear, hearing impairment, tinnitus (head noise), dizziness, ear pain, or facial weakness. The symptoms that you may be having depend on the extent of the disease and where the disease is located.
Medical treatment of chronic ear infections will often be enough to control discharge ,at least temporarily. The ear is usually cleaned by the ENT surgeon in the outpatient clinical settings using the microscope and suction. Ear drops or creams may be used to eliminate the infection. Oral antibiotics may be necessary in certain cases.
With medical treatment for your condition it is important to have frequent ear exams, especially if your ear is draining. If you have pain in or around the ear, increased drainage, dizziness, twitching or numbness in your face or any other unusual developments, you need to call us immediately.
For many years and even today, surgical treatment has provided successful treatment of chronic otitis media to control infection and prevent serious complications. Advancements of surgical techniques have now made it possible to rebuild the diseased hearing mechanism in most cases allowing improved hearing at the same time or after another surgery in few months
The eardrum may need to be replaced and various tissue grafts can be used to replace it. These include the covering of the muscle from above the ear (temporalis fascia) and covering of ear cartilage (perichondruim), or covering from the skull (pericranium). A diseased ear bone may be replaced by an artificial part, a piece of cartilage, or even one of the original hearing bones.
A thin piece of plastic (silastic sheet) frequently is used behind the eardrum to prevent scar tissue from forming and to promote normal function of the middle ear and motion of the ear drum.
When the ear is filled with scar tissue or when all ear bones have been destroyed it may be necessary to perform the operation in two stages. During the first stage of surgery a piece of stiff plastic is inserted to allow more normal hearing without scar tissue. At the second surgery the plastic may be removed. During the operation the area will be examined for recurrent or residual disease and an attempt for restoring hearing is performed. A decision in regards to staging the operation in to two surgeries will be made during the time of the first surgery and is dependent on the findings, that are visualised after opening the middle ear.
SURGICAL PROCEDURES FOR CHRONIC EAR INFECTIONS
This surgery is performed to repair a hole/perforation in the tympanic membrane/ear drum when there is no middle ear disease of the ear bones. This procedure closes the middle ear in a natural way and may improve hearing. Surgery is performed under local or general anesthesia. Tissue grafts are used to repair the defect in the ear drum. The patient may be discharged the same day and may return to work within a week. Healing is complete in most cases in eight weeks. At this time the hearing improvement should be noticed.
The purpose of a tympanoplasty is to inspect the ear spaces for disease and to attempt to improve the hearing loss. The operation is performed to eliminate any infection and repair both the sound transmitting mechanism and the eardrum. This surgery may improve the hearing loss. The surgery may be done in one or two stages. Some patients can go home the same day and some being hospitalized for one night following surgery
Most tympanoplasties,just like myringopolasty are performed through an incision behind the ear, under a local or general anesthetic. The surgery may also be performed through the ear canal. The perforation is repaired with fascia or perichondrium. Sound transmission is achieved by repositioning or replacing diseased ear bones. Occasionally, a piece of cartilage is used to stiffen the eardrum and attempt to stop recurrent retraction pockets or cholesteatoma.
The mastoid space sits at behind and above of middle ear and connects directly with the middle ear space. There are many significant structures in and near to the mastoid including the brain, inner ear and facial nerve. This makes infections risky and surgery delicate. Almost any active process like infection or cholesteatoma will involve both spaces. Therefore, mastoid surgery is frequently necessary in conjunction with tympanoplasty to adequately treat the existing problem.
The mastoidectomy is the procedure to clean out the mastoid space. This is mostly done through an incision behind the outer ear. The outer layer of bone is then removed and the abnormal contents and discharge and debris, are cleaned out. At the completion of the surgery the incision is either glued back together or closed with dissolvable sutures that require little care.
The mastoidectomy with or without a tympanoplasty is an inpatient procedure. One can expect to be discharged after surgery or the next morning. Three weeks of restricted activity are advised. If regular activities require heavy lifting expect three weeks. Most other activities can be resumed sooner.
Modified Radical Mastoidectomy
The purpose of this operation is to eliminate the infection without consideration of hearing improvement. It is usually performed on those patients who have very resistant infections. Occasionally it may be necessary to perform a radical mastoid operation in cases that originally appeared suitable for a tympanoplasty. The decision is made at the time of the surgery. Fat, muscle or bone graft to the ear is necessary at times to help the ear heal properly.
A modified radical mastoidectomy is done under general anesthesia and may require one night of hospitalization. The patient may usually return to work in one to two weeks. Complete healing may require up to four months.