Ear surgery

The ear is a complex system important in hearing and communication. This is an area that your doctor operates in daily and is intimately familiar–both with the anatomy and function.

The most common problem for children is ear infections. This involves recurrent infections and/or persistent fluid in the middle ear space that is usually filled with air. If your child has several ear infections or persistent fluid, tympanostomy tubes may be recommended.

In this section, we will review more involved ear surgery. We will divide this into three sections:

   1) Myringoplasty: A relatively simple repair of an ear drum hole (perforation)
   2) Tympanoplasty: Repair of the ear drum perforation involving evaluation of the middle ear bones (ossicles) and other structures.

   3) Tympanomastoidectomy: Surgery that involves the ear drum, middle ear and mastoid (the hollow bone behind the ear).

What is Myringoplasty?

When there is an opening or hole (perforation) in the ear drum, many times it can be repaired by a relatively straight-forward ‘patching’ of the ear drum (tympanic membrane). The material used can be the patient’s own tissue (fat) or man-made (gelfoam).

We use this method to close smaller openings or when removing tympanostomy tubes. Think of removing a nail from your tire and patching.

This method can be also used when closure is desired but the patient is too young for formal Tympanoplasty surgery (< 7 years).

The procedure is quick, relatively painless, does not affect hearing and has a good record of successful healing (60-85%) depending on the size of the perforation.

What is Tympanoplasty?

Tympanoplasty is repair of the ear drum requiring careful evaluation of the middle ear including the middle ear bones, nerves and other structures. Tympanoplasty is performed when 1) the perforation is large, 2) the perforation presents in a complicated position (next to the edge or ear bones), 3) associated with chronic infection or 4) growth of cholesteatoma (skin cyst). Tympanoplasty is performed also when the ear bones are fixed or disconnected requiring repair: ossiculoplasty.

In this case, man-made ear bones can be used to replace natural ear bones restoring hearing.

The ear drum (tympanic membrane) is repaired using the patient’s own tissue. This allows healing with a minimum of reaction or inflammation. The two most common materials used are fascia (thin tissue covering muscle) and cartilage.

Your doctor will recommend the material used and surgical approach based on the location of the perforation, age of your child, size of the ear canal and history of previous ear surgery.

The usual approaches are: 1) incision behind the ear and 2) through the ear canal.

It is important to understand the post-operative limitations with this surgery. In the pediatric patient it is very important to have reduced activity after surgery allowing the ear to heal successfully.

What are the complications possible after Tympanoplasty?

The most common complication of this surgery is graft failure. In repairing the ear drum, your child’s tissue is used as a scaffold or framework and their own skin grows over it (healing itself). If there is excessive activity or drainage after surgery, the graft will dissolve leaving a hole.

What is Tympanomastoidectomy?

When infection or growth of a cholesteatoma(skin cyst) in the ear extends into the mastoid – the hollow bone behind the ear – surgery involving the middle ear and mastoid is combined to remove all the infection or growth.

In this case, the approach is done through an incision behind the ear. This approach allows your surgeon to remove all the infection or growth while seeing and protecting the important structures like the balance system, ear bones, nerves and hearing organ (cochlea).

Tympanomastoidectomy surgery for cholesteatoma is unique because it usually involves and “second look” procedure no sooner than six months after the first surgery. If the cholesteatoma has not recurred, reconstruction of the hearing mechanism (ear bones) can be completed.

What are the possible complications of tympanomastoid surgery?

Because your surgeon has expert knowledge in the anatomy and function of the ear, complications are unusual. However, if your child has a particularly bad infection or extensive growth of cholesteatoma, your surgeon will outline areas of possible concern or increase complication risk.

The possible complications that can occur with this surgery include: graft failure, decreased hearing, dizziness, ringing in the ear, deafness, facial nerve damage (facial paresis or paralysis), spinal fluid leak and meningitis.