Middle Ear Surgery
There are a number of different operations carried out for middle ear problems. The commonest are myringoplasty or tympanoplasty to repair a perforation in the eardrum, mastoid surgery to deal with chronic ear disease and stapedectomy to correct a hearing loss due to fixation of the stapes bone.
The operation
a) Myringoplasty/tympanoplasty
This is an operation to repair a perforation of the tympanic membrane, and possibly reconstruct the little bones of hearing (ossicles). This operation is usually carried out through an incision behind the ear, although occasionally it may be possible to do it down the ear canal. The operation takes about an hour.
b) Stapedectomy
This is an operation carried out to relieve hearing loss in the condition of otosclerosis where the stapes (stirrup) bone is fixed due to new bone formation. In this operation, the stapes bone is removed and replaced by a Teflon prosthesis. The operation is carried out down the ear canal and takes about an hour. Post-operatively, there will be packing in the ear canal for 1 to 2 weeks.
c) Mastoid surgery
Mastoid surgery is usually carried out for chronic ear infections (cholesteatoma). It is usually carried out through an incision behind the ear and may take up to 3 hours. Post-operatively it is common to have packing in the ear canal for 2 to 3 weeks.
If there has been an incision, it will usually be closed with dissolvable stitches, which do not need removing.
Length of stay in hospital
Most ear operations are done as a day-case; however, occasionally it may be necessary to stay in hospital overnight.
Post-operative symptoms
It is quite common to feel slightly unsteady or dizzy for a day or so post-operatively, and the hearing may be made worse by the operation, especially with packing in position. Any tinnitus (noises in the ear) may also be worse for a few days after the surgery.
In general, ear operations are relatively pain free, although some discomfort is felt behind the ear when an incision has been made. Painkillers will be provided and should be taken regularly for the first few days.
It is quite common to feel slightly unsteady or dizzy for a day or so post-operatively.
Post-operative care
It is important to avoid heavy lifting, straining or flying for the first 6 weeks after surgery to allow the middle ear to heal properly.
a) Hair washing
As a general rule, we advise you not to wash your hair for 4 to 5 days after ear surgery in order to keep the ear and the incision dry. However, if you can obtain the help of a friend or relative, you may be able to wash your hair sooner, taking care to keep water off the operation site and then drying the hair with a cool hairdryer.
b) Ear packing
Many of the operations require the use of a ribbon gauze pack to keep open the ear canal and to help heal the tissues in the ear. Most of the packs remain in place for between 1 and 3 weeks and are then removed in out-patients. If part of the pack should come out of the ear canal, it should be trimmed and the tail tucked back in.
Length of time off work / School
Usually it will be necessary to take 2 weeks off work or school, but if your job involves heavy lifting or strenuous work, this should be avoided for 6 weeks.
Possible complications of ear operations
Most ear operations are straightforward, but with any operation there is always a small risk of a complication.
a) General Anaesthetic
General anaesthetics are very safe in this day and age. The Anaesthetist will visit you / your child on the ward before the operation and discuss the risks of the anaesthetic and any other concerns with you.
b) Hearing loss
As Ear Surgeons, we are always concerned with preserving hearing whenever possible, and improving it when circumstances allow. Much of the surgery is designed to improve hearing. However, in certain operations, such as mastoid surgery, it may not be possible to achieve the eradication of infection without some loss of hearing. You will be warned of this pre-operatively. With any ear surgery there is a small risk of complete hearing loss.
c) Tinnitus (noises in the ear)
Although rare, there is a small risk that tinnitus may be made worse after ear surgery.
d) Dizziness
It is quite common to get some mild dizziness post-operatively, but this is usually temporary and settles within a few hours or within a day or so.
e) Facial nerve weakness
The nerve that moves the muscle of the face passes through the middle of the ear and may, very rarely, be damaged by ear surgery causing weakness of the face. This is rare and usually temporary but may, very rarely, be permanent.
f) Taste disturbance
The nerve carrying taste sensation from the tongue passes through the middle of the ear and may, rarely, be involved in the surgery and result in a metallic taste on one side of the tongue. This is usually temporary, but may occasionally be permanent.
g) Numb pinna (outer ear)
If you have an incision made behind the ear, it is common to have a temporary numbness of the pinna (outer ear) for a few weeks whilst the sensory nerves regrow.
h) Infection
Very rarely following ear surgery a wound infection may develop which may require antibiotic treatment.
If you have any concerns once you have returned home, do not hesitate to telephone for advice to one of the following numbers:
Children & Young Persons Unit: 0117 9804000 ext 4544
Level 4 ward Tel: 0117 9804000 ext 4283
Spire Bristol Hospital Tel: 0117 9804000
or myself for advice via my PA Mrs Lorraine Goulder Tel: 0117 9804050