The ear is made up of three basic parts: the outer ear, the middle ear, and the inner ear. The middle ear is an air-filled cavity which consists of an eardrum and three tiny, interconnected bones called the malleus, incus, and stapes. Middle ear surgery is used to treat a variety of conditions in any of these parts. Most ear surgery is microsurgical, performed using an operating microscope to enable the surgeon to view the very small structures of the ear.Latest in trend is Endoscopic Ear Surgery.We, at Siddham ENT Hospital were 1st to perform endoscopic ear surgery in Rajasthan and has the most experienced team to perform the same.
Endoscopic Ear Surgery :
Endoscopic Ear Surgery is rapidly gaining momentum around the world as an ideal alternative technique for small to medium cholesteatoma and tympanoplasty surgery. Endoscopic, minimally invasive, ear surgery is relatively a young technique. Traditional microscopic procedure relies on wide exposure through a straight line access by making a large incision behind the ear. This requires a very different set of surgical skills than endoscopic ear surgery through the natural ear canal.
Advantages of Endoscopic Ear Surgery are:
- No need for postural incision (which may be up to 10 cms)
- Less pain
- Early Recovery
- Heads on Vision during Surgery (enabling better disease clearance)
- Provides a wide view that enables surgeons to look “around the corner”.
- surgically induced trauma is quite limited, therefore less bleeding (in comparision to postaural approach in which many layers of tissue are violated and a tremendous amount of healthy bone is removed.
SURGICAL PROCEDURES FOR CHRONIC EAR INFECTIONS
This operation is performed to repair a hole in the eardrum when there is no middle ear infection or 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 hospitalized for one night 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. A tympanoplasty is an outpatient procedure with some patients going home the same day and some being hospitalized for one night following surgery
Most tympanoplasties 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 accomplished 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 connects directly with the middle ear space. There are important structures in and adjacent 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. This is generally done through an incision behind the outer ear. The outer layer of bone is then removed and the abnormal contents 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 outpatient 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.
Mastoidectomy (modified) Radical:
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 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.
If a modified radical or radical mastoid is performed the opening to the ear canal sometimes needs to be enlarged by removing a portion of the cartilage in the ear. This is called a meatoplasty. After this procedure is performed, routine cleaning of the mastoid cavity is more easily accomplished.
WHAT TO EXPECT FOLLOWING SURGERY
In most cases you may return to work in a week to ten days. Healing is usually complete in eight weeks, although hearing improvement may not be noted for a several weeks.
There may be some symptoms that may follow any ear operation:
Taste disturbance and mouth dryness:
It is not uncommon for there to be taste disturbance and mouth dryness following ear surgery. In some cases the disturbance is prolonged and permanent. This is due to involvement of a nerve that goes through the middle ear with the disease process. It supplies taste sensation to only one part of the tongue.
Tinnitus (head noise) frequently is present before the surgery and most often is present temporarily after the surgery. It may persist for one to two months and then decrease in proportion to the improvement of your hearing. It may also persist especially if the hearing loss does not improve or worsens. The tinnitus may persist and may become worse.
Temporary loss of skin sensation in and around the ear is common following surgery. This numbness may involve the entire outer ear an may persist for six months or may be permanent.
The joint where the jaw is located is located at the front of the ear canal. Some soreness or stiffness in the jaw movement is very common after ear surgery. This soreness or stiffness will decrease and usually go away within one to two months.
Drainage behind the Ear:
On occasion the surgeon will need to insert drain tube behind the ear. The need to insert a drain after surgery is usually not apparent before the surgery. Should a drainage tube be needed it will be removed during the post operative phase of healing.
Ear pressure or a “popping” sensation or mild equilibrium disturbance may occur from the packing in the middle ear. When the packing is removed post-operatively this sensation will disappear.