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 eardrum, with thickened or inflamed tissue 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.

When chronic infection or cholesteatoma is present in the ear, tympanoplasty is then usually combined with another of the below procedures. The approach depends on the extent of the problem and can be through the ear canal with a microscope or endoscope or with an incision in the opening of the ear canal or behind the ear.

Chronic ear procedures are performed under local or general anesthesia. They are out-patient procedures and take 1-3 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, or ossicular chain reconstruction- if required


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 bony cylinder of the ear canal is kept in place
  • Canal Wall Down: The bony 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 and this is called mastoid obliteration.
Mastoid Surgery Images

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 patient’s own tissues may be used (cartilage or bone) or foreign materials (plastic, stainless steel and titanium) called prosthesis may be used. One or all bones in the middle ear may need to be replaced.

Ossicular Chain Reconstruction Surgery Images

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. 

Ventilation Tube Insertion