This letter is designed to familiarize you with the ear surgery, which you are considering to repair your eardrum, possibly stop a draining ear, resolve an infected mastoid bone or reconstruct your ear bones.  In all likelihood you have had a series of ear infections or ear problems, which have persisted for many years.  You may have simply developed hearing loss which gradually occurred as result of a fixation of the smallest ear bone called otosclerosis.  All of the above may have affected not only your ability to hear, to localize sound but also may have affected the nerve of hearing or the mechanism by which sound is transmitted to the inner ear.  This can include problems affecting the ear drum such as tympanosclerosis also known as scarring of the ear drum. This scarring or any recurring inflammatory or infectious process can affect the ear bones called the stapes, incus and malleus.  The problem may have affected the lining tissue below the eardrum causing chronic inflammation and swelling of this tissue.  In addition your eustachian tube, which is the tube connecting your nose and ears, allowing for equalization of air pressure may have been permanently affected.  Indeed generally it is this eustachian tube problem which is the real cause of most ear problems.  Problems such as otosclerosis are often a genetic related hearing loss which gradually progresses. The loss of hearing due to otosclerosis can be helped with surgery or a hearing aid for those preferring no surgery.

There are a variety of techniques, which I will utilize in order to improve your ear problems.  This may include surgery, which is localized to the eardrum also known as myringoplasty.  In this technique, generally I will place a small graft of tissue through the freshened edges of your perforated eardrum in order to reconstruct the eardrum.  This is a very low risk operation and I usually use a small amount of tissue from your ear lobe area.

In situations where the ear drum perforation is somewhat larger tympanoplasty surgery, which involves lifting up the eardrum and placing a graft either below or above the eardrum, may be necessary.  Generally when I perform a tympanoplasty I will also inspect the ear bones to be sure that they are normal and in the proper position.  A  graft can then be placed below the eardrum and supported with material called packing to help stabilize it in position until a new blood supply grows into the area and helps the graft to survive.

Tympanoplasty can be approached either through an ear canal incision or an incision behind the ear.  The approach utilized will depend on the position of the perforation as well as various other anatomic considerations.  The incision behind the ear heals quickly and will generally have absorbable suture material placed.

During a tympanoplasty if there is evidence that the ear bones are not connected properly then repair or reconstruction of the ear bones will be undertaken if at all feasible at that time.  In situations where a cholesteatoma or sac of skin  trapped below the eardrum is present the ear bone or ossicular reconstruction may be delayed until a second look procedure is performed.  This second look procedure is usually performed a year or so after the initial operation to remove a cholesteatoma.  Reconstruction of the ear bones is accomplished with synthetic materials and sometimes with cartilage or tissue obtained from your own body.

If a mastoidectomy or drilling of the mastoid bone is necessary then you'll have to incision done behind the ear to gain access to the mastoid bone.  This is often necessary in cases of cholesteatoma or a chronically draining ear.  If possible the mastoidectomy will be accomplished in what is called or termed a canal wall up procedure.  This allows the ear canal to maintain its usual shape.  This enables the ear to be a normal self-cleaning ear.  In situations where the ear canal wall cannot be kept intact then a canal wall down or traditional mastoidectomy will be performed.  In these situations your ear will need to be examined on a regular basis generally every 6 to 12 months for cleaning and visualization of any problems.  Although these cavities generally heal without difficulty it can take six months to a year for the cavity to reach this state.

Otosclerosis or fixation of the stapes ear bone is repaired by replacing the fixated ear bone with a prosthetic or replacement ear bone.  Most times this can be accomplished without difficulty but in certain instances there may be anatomic considerations which preclude and do not allow the surgery to be successfully completed some of these include an overhanging facial nerve, a persistent stapedial artery, a floating footplate or a stapes gusher.

The risks of ear surgery are generally dependent upon the extent of ear surgery.  A myringoplasty has very limited risk.  The greatest risk being a reperforation or persistence of the perforated eardrum.  In general tympanoplasty or myringoplasty have an approximately 95 percent success rate.  The larger the perforation and the more times an attempt has been made to close the hole in the ear drum the less likely the chance of successful surgery.  In almost any ear surgery because one lifts up the eardrum there is a small risk of injury to the nerve of taste or the chorda tympani.  This nerve runs just below the eardrum and in almost all cases is not injured.  Sometimes patients will complain of a temporary metallic taste due to stretching of the nerve during tympanoplasty.  It is quite unusual to have a significant taste change as a result of tympanoplasty but it can be more common with mastoidectomy or stapedectomy.  With more extensive surgery such as tympanoplasty, mastoidectomy or stapedectomy or removal of a cholesteatoma or reconstruction of ear bones it is possible to have hearing loss, tinnitus or ringing in the ear, imbalance, facial nerve injury, meningitis, brain access, reperforation, need for additional reconstruction of the ear bones and possibly other complications as result of the surgery.  Fortunately I have not experienced any significant complications in my patient population for the period of time I've been doing this type of surgery.  That is not to say that minor complications such as a reperforation or need for additional reconstruction have not occurred.  However these are not the commonplace occurrences and fortunately no patients have suffered any major or catastrophic complications as result of the surgery.

After the surgery is completed a follow-up will generally be arranged in the office within a week or ten days after the surgery.  If a mastoidectomy is performed the follow-up may be sooner.  Packing which is placed in the ear canal or mastoid cavity will not be removed for at least 10 or more days after the surgery.  This allows for proper healing and stabilization of the grafts to occur.  Patients will be provided with prescriptions for eardrops, which they should use at least twice daily.  It is important to keep the ear dry until you are instructed otherwise.

 Please feel free to contact our office if you have any questions.                                                             

Stephen E. Guilder M.D.