Information on ear operations
Introduction
The purpose of this information is to inform you about the course of this procedure, we ask you to do so
read the document carefully. Your surgeon is at your disposal to answer any further questions you may have. Of course, it may be the case that certain aspects of this document are not applicable in your individual case or that they need to be discussed more or additionally with your surgeon. Remember to report to your surgeon all information regarding your general health, as well as any medications you regularly take (especially aspirin and related products or other medications that may affect clotting). Do not forget to report if you have experienced any allergic reactions, especially reactions to medication. Bring any recent medical records in your possession, such as blood results, radiologic and other preoperative exams. Questions regarding the general anaesthetic – if applicable – are best discussed in advance with the physician-anaesthetist.
Before going into the technical aspects and purpose of the procedure, it is useful to explain how the ear works. Sound consists of air vibrations. These vibrations come through the ear canal to the eardrum. The eardrum and the ossicles amplify and conduct the vibrations to the cochlea. The cochlea contains the sensory (nerve) cells, which convert the vibrations into nerve impulses. These nerve impulses are carried via the auditory nerve to the brain, where they are translated into “hearing”. Under normal circumstances, the middle ear is filled with air, which has the same pressure and composition as outside air. The Eustachian tube allows for exchange so that the air pressure in front of and behind the eardrum is the same.
The ear can be roughly divided into:
the external auditory canal;
the eardrum with the middle ear behind it. It contains three ossicles, which together form the ossicle chain: the malleus (malleus), the anvil (incus) and the stirrup (stapes). The middle ear is connected to the nasopharynx via the Eustachian tube.
the actual organ of hearing, also called the cochlea or inner ear.
Schematic ear with:
ear canal
eardrum
hammer
anvil
stirrup
middle ear
vestibular system
Eustachian tube
snail shell
vestibular nerve
facial nerve
auditory nerve
Hearing loss can be due to an inner ear loss (sensorineural hearing loss) or a conductive hearing loss (transmission loss). Sensorineural hearing loss involves damage to the nerve part. With a conduction loss, there is insufficient transmission of sound from the ear canal to the cochlea. The cause of the hearing loss is usually in the middle ear. For example, due to permanent damage to the eardrum or the ossicles after an ear infection. In this section only those operations where conduction loss is present are discussed.
Purpose of the procedure
If there is hearing loss due to a defect in the middle ear, surgery can usually improve hearing. This is the case with a hole (perforation) in the eardrum, or with an interruption or fixation of the ossicles. Sometimes, in addition to the hearing loss, there is a chronic inflammation in the middle ear (cholesteatoma) and the aim of the surgery is initially to heal the ear of the inflammation . The surgeon will also try to restore hearing as well as possible in that situation, but depending on the seriousness of the situation, this is not always possible. Your doctor will discuss this with you beforehand.
The technical aspects of the operation
Tympanoplasty (repair of the eardrum)
This operation is performed to close a hole in the eardrum. Your own tissue or an allograft (donor) eardrum can be used for this. Own tissue can be fascia, this is the thin membrane that surrounds a muscle behind the ear or cartilage tissue originating from the pinna. The procedure can be done through the external auditory canal or through an incision behind the ear. After the procedure, a bandage is placed in the ear consisting of synthetic sponges in ear ointment and a bandage behind the ear in case of incision and stitches. A large bandage is placed around the head during the first 24 hours after the procedure. The bandage in the ear remains in place for seven days.
Ossiculoplasty (repair ossicles)
When there is hearing loss due to reduced sound transmission via the ossicles, this may be due to an interruption of the ossicles (after inflammation) or by a fixation (otosclerosis or tympanosclerosis). Fixation by otosclerosis is discussed in a separate chapter. The procedure is usually performed through the external auditory canal, whereby the eardrum is detached and lifted. The repair can be done with your own tissue, plastic or donor material. Your doctor will discuss this with you in advance, depending on the situation. The goal is to improve hearing. This procedure can also be combined with the repair of the eardrum. A bandage is placed in the ear consisting of synthetic sponges in ear ointment. The bandage remains in place for several days.
Otosclerosis
Otosclerosis is a progressive disease that slowly makes a person hard of hearing. The hearing loss can occur in one or both ears in otosclerosis. The cause is an abnormal overgrowth of the bone, causing a progressive fixation of the stapes. By sticking the stirrup, there is a less good transfer of the sound vibrations and a conduction loss occurs. The process can also occur in the cochlea, causing sensorineural hearing loss.
When there is mainly a conduction loss, surgery can improve hearing. The procedure is performed along the external auditory canal, lifting the eardrum. The stirrup is partially replaced by a plastic leg. After the procedure, a bandage is placed in the ear canal, consisting of sponges in ear ointment. The bandage remains in place for several days.
cholesteatoma
A cholesteatoma is a chronic inflammatory process in which skin grows through the eardrum into the middle ear and forms a cyst. This cyst has a destructive effect due to its growth
character and can affect the ossicles, the vestibular system, the facial nerve and even grow into the inner ear. Hence the importance of a surgical procedure to remove the cyst. Sometimes multiple operations may even be required to remove the cholesteatoma permanently. During the procedure, an incision is always made behind the ear. The mastoid cavity (air-containing cells behind the ear) is drilled open in this way to allow complete removal of the cyst. The aim of the operation is initially to remediate the ear and to free it from the chronic inflammatory process. In the second instance, the surgeon will try to restore hearing, but depending on the situation, this will not always be possible. The surgeon will discuss this with you in advance as well as possible. After the procedure, a bandage is placed in the ear consisting of sponges in ear ointment. There are stitches behind the ear. A large bandage is placed around the head for the first 24 hours. The stitches and bandage in the ear are removed after one week.
The immediate consequences
You may experience mild pain after ear surgery. If there is a large bandage, this can cause pressure and tension. This feeling of pressure disappears when the bandage is
will be removed. You may take painkillers if necessary. The sensitivity of the pinna may be reduced; there may be a temporary numbness that disappears after a few weeks or months. Temporary dizziness may occur after ear surgery, as the ear and
balance organs are close together. Report this to your doctor. Temporary taste disturbances may occur. There may be a slight temperature increase in the first 24 hours after the procedure. There may be some bloody fluid from the ear canal for the first few days; this is normal.
If one of the sponges falls out of the ear canal, don't worry; DO NOT try to put it back in. Your hearing will not improve for the first few days, given the presence of the bandage. A popping sound and ringing in the ears after the procedure is normal.
The belated consequences
If the aim of the surgery is to improve your hearing, such as with a tympanoplasty, a
ossiculoplasty or otosclerosis, this will only be assessed a few weeks after the procedure. It
healing process happens rather slowly and progressively. You will have to apply local care in the form of ear ointment or ear drops every day for the first weeks after the procedure.
Serious and/or exceptional complications.
Any surgical procedure, even performed under ideal conditions and in the best possible manner, can entail complications. All these risks must be weighed up against the benefits that can normally be expected from an intervention, and it must not be forgotten that “not intervene” can sometimes also have serious consequences. You should report any sudden onset or worsening dizziness or pain to your doctor. Heavy or bad smelling ear canal or fluid from the wound behind the ear is rare, but you should report it to your doctor. Likewise, the occurrence of facial paralysis.
