Surgical Options
Myringoplasty- Myringoplasty is the operation performed
for the purpose of repairing a perforation in the eardrum when
there is no middle ear infection or disease of the ear bones.
This procedure seals the middle ear and improves hearing in many
cases.
Surgery is usually performed under general anesthesia through
the ear canal or from behind the ear. Ear tissue is used
to repair the defect in the eardrum. The surgery is done
on an out patient basis. Healing is complete in most cases
in six weeks, at which time any hearing improvement is usually
noticeable.
Tympanoplasty- An ear infection may cause a perforation
in the eardrum and may also damage the three bones that transmit
sound from the eardrum to the inner ear and hearing nerve.
Tympanoplasty is the operation performed to repair both the
sound transmitting mechanism and any perforation in the eardrum.
This procedure seals the middle ear and improves hearing in
many cases.
Surgery may be performed through the ear canal or from behind
the ear, under a local or general anesthetic. The perforation
is repaired with the ear tissue called fascia or perichondrium
in most cases. Sound transmission to the inner ear is accomplished
by repositioning or replacing diseased ear bones.
In some cases it is not possible to repair the sound transmitting
mechanism and the eardrum at the same time. In these cases
the eardrum is repaired first and, four months or more afterward,
the sound transmitting mechanism is reconstructed.
Surgery is done on an outpatient basis and patients may return
to work in several days to a week. Healing is usually complete
in eight weeks. Hearing improvement may not be noted for
a few months.
Tympanoplasty with Mastoidectomy
Tympanoplasty with mastoidectomy is performed in cases when
the chronic ear infection is more extensive. It may be performed
to remove infection from the mastoid and middle ear or to
remove a cholesteatoma (a skin-lined cyst).
A cholesteatoma or chronic ear infection may persist for many
years without difficulty except for annoying drainage or hearing
loss. However, by local extension and pressure, it begins
to involve important surrounding structures and will eventually
destroy the ear and become a focal point for meningitis.
If this occurs, the patient will often have a fullness or
low-grade, aching discomfort in the ear region. Dizziness
and weakness of the face may develop in severe cases. If
any of these symptoms occur, it is imperative that one seek
immediate medical care and surgery is usually necessary to
eradicate the infection and prevent serious complications.
When the infection or cholesteatoma is wide-spread, surgical
elimination may be difficult. Surgery is performed through
an incision made behind the ear with the objective of being
able to eliminate the infection and provide a safe dry ear.
The proceedure is done on an outpatient basis.
In most patients with a cholesteatoma, it is not possible
to eliminate infection and restore hearing in one operation.
The infection is eliminated and the eardrum rebuilt in the
first operation. This requires a general anesthetic and is
done on an outpatient basis. The patient may return to work
in seven to ten days. If the second operation is necessary,
it will be performed four to six months later to restore the
hearing mechanism and re-inspect the ear for any residual
disease and or cholesteatoma. On occasion, a radical mastoid
operation may be necessary to control infection in a case
thought originally to be suited for intact canal wall tympanoplasty
with mastoidectomy.
Tympanoplasty: Planned Second Stage- The purpose of
this operation is to re-inspect the ear spaces for disease
and to improve the hearing. Surgery may be performed through
the ear canal or from behind the ear, under a local or general
anesthesia. The ear is inspected for any residual disease.
Sound transmission to the inner ear is accomplished by replacing
missing ear bones.
Surgery is done as an outpatient and the patient may return
to work in seven to ten days. Healing is usually complete
in eight weeks. Hearing improvement is frequently noted at
that time.
Tympanoplasty with revision Mastoidectomy- The purpose
of this operation is to eliminate discharge from a previously
created mastoid cavity defect and to improve the hearing.
The operation is performed under general anesthesia through
an incision behind the ear. The mastoid cavity may be obliterated
with fat from behind the ear, with bone, or with a temporalis
muscle flap. At times the ear canal may be rebuilt with cartilage
or bone. The eardrum may be repaired and if possible the
hearing mechanism is restored. In most cases however, a second
operation is necessary to obtain hearing improvement (see
Tympanoplasty: Planned Second Stage). Surgery is done as
an outpatient. Complete healing of the inside of the ear
may take four to six months.
Radical Mastoid Operation
The purpose to this operation is to eradicate the infection
without consideration of hearing improvement. It is usually
performed in those patients who may have very resistant infections.
Occasionally it may be necessary to perform a radical mastoid
operation in some cases that originally appeared suitable
for a tympanoplasty. This decision is made at the time of
surgery. A fat or bone graft from the ear is necessary at
times to help the ear heal properly.
The radical mastoid operation is performed under general anesthesia
as an outpatient. The patient may usually return to work
in one to two weeks. Complete healing may require up to four
months.
Mastoid Obliteration Operation
The purpose of this operation is to eradicate any mastoid
infection and to obliterate (fill-in) a previously created
mastoid cavity. Hearing improvement is not considered.
The operation is performed under general anesthesia through
an incision behind the ear. The mastoid space is filled with
fat (from the neck or abdomen), bone, or a temporalis muscle
flap or some combination of these. Surgery is done as an
outpatient. Complete healing may require up to three months.
