-EL PASO HEAD & NECK SURGERY- Ear, Nose and Throat



MASTOIDECTOMY (often combined with tympanoplasty)Terminology:Mastoidectomy: surgical procedure to remove/open the mastoid air cells. Acquired cholesteatoma: The ear drum is lined with skin (squamous) cells just like the back of your hand. And just like the back of your hand, these skin cells are constantly sloughing. If you ear drum is retracted, these sloughing skin cells can get trapped leading to a collection of squamous debris. Because the ear drum continues sloughing, this collection can continue to grow and become locally destructive. It can affect several important structures:Ossicles: leading to hearing lossFacial nerve: leading to weakness or paralysis of the muscles of the faceSkull base: leading to erosion through the skull and potentially creating a route for infection to spread intracraniallyInner ear structures: the balance organs (semicircular canals) and the hearing organ (cochlea) can both become affectedCongenital cholesteatoma: rarely a cholesteatoma can be seen in a patient without Eustachian tube dysfunction. This is generally thought to be the result of a rest of skin cells in the middle ear space. Conductive hearing loss: hearing loss caused by incomplete conduction of soundwaves from the environment to the inner earSensorineural hearing loss: hearing loss caused by an abnormality of the inner ear, hearing nerve or the central processing systems of the brainRelevant Anatomy:Mastoid cells: a section of the skull located primarily behind the ear which is hollowed out into a number of air filled spaces that vary greatly in their size and number. Eustachian tube: tube that connects the middle ear with the back of the nose and equalizes the pressure between the middle ear and the atmosphereGenerally opens when we swallowing, chew, yawn and when we actively force air through it (“popping or clearing your ears”).Ossicles: 3 small bones (malleus, incus, stapes) within the middle ear space that conduct soundwaves from the ear drum to the inner ear. Normally the ear drum only touches the first ear bone (malleus) but with retraction it can contact the second (incus) and even the third (stapes ) bones. These bones are very susceptible to erosion from either the retracted ear drum and/or cholesteatoma. Erosion can cause a significant conductive hearing loss. Facial nerve: the large nerve that controls all the muscles of facial expression on that side of the face.This nerve passes through the middle ear Indications for surgery:This may be performed to treat an infection (mastoiditis)As part of a complete removal of a cholesteatomaTo help improve ventilation of the middle ear in the case of chronic eustachian tube dysfunction Allow improved access to the middle ear space in the case of various middle ear implants (i.e. cochlear implant, vibrant sound bridge)Postoperative considerations:You will have an incision behind your ear. It will likely be covered with skin glue. It is ok to get this area wet after 48hrs however do not scrub the area or try to pick the skin glue off. The glue will slowly peel off starting about 2 weeks after surgery. You will be seen 6 weeks after surgeryUntil then, avoid blowing your nose and any activity that will cause you to bear down strongly potentially forcing air up through the Eustachian tube and into the middle ear. Try to sneeze with your mouth open. You will have a dressing on your ear that can be removed 24hrs after surgery; its ok if it falls off early. Your ear canal will be packed with absorbable packing which will make it difficult to hear when you wake upYou will start drops 2 weeks before your follow up to help dissolve this packingYou may notice a metallic taste in your mouth or other changes in taste This is usually temporary but can take several months to resolve completelyKeep your ear canal dry (except for the use of ear drops as prescribed) until you are seen for your follow up visit. This means no dunking your head in a pool, hot tub or bathtub. In the shower, you may place a cotton ball at the opening of the ear canal. Cover the cotton ball with a small amount of Vaseline to create a water tight seal. Risks of surgery: Pain: typically mild to moderate, narcotic pain medications may be required for 2-7 daysNon-narcotic medications (Ibuprofen/Tylenol should be adequate after)Infection: very rare, foul smelling drainage from your ear may be a sign of an infectionIf this happens, contact the clinic and we will likely instruct you to start drops earlyDamage to surrounding structures:Facial nerve: damage to this nerve is very rare with this procedure alone. If it occurred you would notice weakness or paralysis of one side of your face Ossicles: these small bones may be damaged prior to surgery from chronic ear disease but can also be inadvertently injured during surgery. This may cause hearing loss or rarely dizziness. Persistent/new perforation: If you already have a hole in the ear drum, there is approximately a 90% chance that this procedure will close the hole. However it can fail and lead to a persistent hole. If the tympanoplasty is being performed for retraction, there is a chance of developing a new hole after surgery. Sensorineural hearing loss: chronic ear disease generally causes a conductive hearing loss, however, surgery in the middle ear can rarely cause a nerve hearing loss. This occurs in less than 1% of patients and is thought to be related to microtrauma in the inner ear.The degree of hearing loss can vary from a mild to a profound hearing loss.We would not know if this occurred until sometime AFTER your surgery; it is not something than can be identified intraoperatively.Persistent/worsened hearing loss: if you have hearing loss prior to surgery, there may be an improvement in the hearing however there is always a risk that the hearing will get worse after surgery. If the degree of hearing loss is more than expected, additional procedures may be warranted to explore the ear and attempt to improve the hearing further.Need for additional procedures: additional surgeries may be required in the future to address any complications or future ear disease.Risks of anesthesia: this includes but is not limited to bad reactions to the medications, nausea, vomiting, heart attack, stroke, and death. These risks will be discussed in more detail by the anesthesia care providers. ................
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