Chronic Ear Surgery

Chronic ear surgery refers to many surgical procedures that may be performed when there is chronic infection or other chronic problems in an ear. Chronic infections usually occur in the setting of a hole in the ear where acute infection has failed to resolve, leaving thickened or inflamed tissue behind in the middle ear and/or mastoid cavity. This can make the ear wet, cause recurrent or chronic ear drainage, irritation, pain, hearing loss and other possible complications.

Cholesteatoma is a cyst of skin that can form in the ear and frequently accompanies chronic ear disease. Chronic infection and cholesteatomas frequently cause problems with the bones of hearing and cause more hearing loss than the ear drum perforation alone can cause.

Cholesteatoma - Ear Associates, San Jose, CA
Cholesteatoma that has invaded the mastoid and surrounds the bones of hearing

When chronic infection or cholesteatoma is present in the ear, tympanoplasty surgery is frequently not enough to address the problems of the ear. It needs to be combined with these other procedures:

Mastoidectomy:

This involves opening the mastoid bone with a drill to remove infected tissue or cholesteatoma or to gain access to other areas of the ear that have infection or problems.

  • Canal Wall Up: The boney cylinder of the ear canal is kept in place
  • Canal Wall Down: The boney cylinder of the ear canal is removed to gain more exposure in to the mastoid. The mastoid cavity is often then filled in with bone or cartilage grafts (mastoid obliteration) to try to keep the anatomy as normal as possible
Mastoidectomy at Ear Associates, San Jose, CA
Canal wall up mastoidectomy
with removal of the bones of hearing

Canal wall down mastoidectomy with removal of the bones of hearing

Ossicular Chain Reconstruction

This is a broad term to describe many different types of procedures to repair or replace the bones of hearing that may have been destroyed by infection, cholesteatoma or removed during previous surgeries. The patients own tissues may be used (cartilage or bone) or foreign materials (plastic, stainless steel and titanium) called prostheses may be used. One or all bones in the middle ear may need to be replaced.

Ossicular Chain Reconstruction at Ear Associates, San Jose, CA
Titanium total
ossicular prosthesis
Cartilage cap placed on
top of prosthesis
Reconstructed ear drum
on top of cartilage

Ossicular Chain Reconstruction at Ear Associates, San Jose, CA
Hearing bones reconstructed
with bone cement
Bone cement and titanium prosthesis

Ossicular Mobilization

Extensive scar tissue formation can occur in the ear and need to be dissected from the bones of hearing. This process can mature into bone formation and the new bone formation has to be removed from the bones of hearing to get them moving again and for the hearing to return.

Ventilation tube insertion

Eustachian tube problems are usually at the root of chronic ear problems and sometimes it is necessary to put a tube in the ear to prevent on-going problems. Click here to learn more about Ventilation Tube Insertion

Encephalocele/CSF leak closure

When disease is extensive, the bone between the brain and the middle ear or mastoid can become eroded and result is a spinal fluid leak during surgery, or a hole that needs to be reconstructed may be found.

Chronic ear procedures are performed under general anesthesia although procedures to correct hearing loss alone can be performed under sedation with local anestheasia. They are out-patient procedures and take 1-4 hours depending on the exact procedure and extension of the problem. Many ear problems require two operations to fix the many problems that can exist. The first operation, or first stage, is to cure the infection and remove cholesteatoma. The second operation, or second stage procedure, is to ensure no return of cholesteatoma and to perform the hearing bone repair if required.

Complications:

Failure of the surgery to fix the ear drum, remove all infection or cyst can occur. Pain, infection and bleeding are complications of any surgical procedure. These are fortunately rare in ear surgery. Blood loss after tympanoplasty surgery is usually too small to measure. The ear is numbed with long lasting drugs that generally keep the patient comfortable for many hours. Most patients use Tylenol or Motrin/Advil for pain. Narcotics are occasionally used. Infection after ear surgery is very rare. Antibiotics are used for 1 week after medial and lateral tympanoplasty.

Most surgeries are performed via an incision behind the ear. The ear may stick out for a couple of weeks and then returns to normal position. The outer ear is often numb for several months, but most of the sensation eventually returns.

Failure to repair a hole of the eardrum if one exists may occur. The frequency of this depends on its size, location, health of the ear and procedure chosen. It can occur in up to 8% of difficult cases. Most patients can then go on to have revision surgery which is usually successful.

Hearing loss. Most patients enjoy improvement of their hearing after successful chronic ear surgery. Scar tissue formation, on-going Eustachian tube problems and irreparable problems with the bones in the middle ear can result in on-going hearing loss. The hearing can rarely be worse after surgery. Conductive, sensorineural or mixed hearing loss may occur. If there is extensive cholesteatoma in the ear, a profound hearing loss can rarely result in its removal. Tinnitus, or ringing in the ear can occur if the hearing worsens.

Taste change can occur after ear surgery due to a nerve of taste that runs under the eardrum and brings taste to the side of the tongue. Loss of taste on the side of the tongue can occur in up to 10% of ear procedures and last for a few months. It can rarely be permanent and is more of a problem in patients who have had surgery in their other ear.

Vertigo and dizziness is common after ear surgery but is usually short-lived and rarely persists. Many medications are given during surgery to prevent nausea and vomiting.

Facial nerve paralysis is a very rare complication of ear surgery. The facial nerve travels through the ear and can rarely be injured during surgery. A facial nerve monitor is used during medial and lateral tympanoplasty which delivers an EMG of the facial nerve to prevent injury.

Injury to the brain, spinal fluid leaks and meningitis is an extremely rare complication of chronic ear surgery and occur in extremely diseased ears in which a lot of bone destruction has occurred between the brain and ear.

 

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