- EL PASO HEAD & NECK SURGERY-EAR, NOSE & THROAT- …



TYMPANOPLASTYTerminology:Tympanoplasty: surgical procedure to reconstruct the tympanic membrane (ear drum)There are many ways to perform this surgery. The technique used is based on several clinical findings and sometimes is not determined till the time of surgeryTympanic membrane perforation: a hole in the ear drumTympanic membrane retraction: chronic eustachian tube dysfunction can lead to a vacuum affect in the middle ear which over time can cause the ear drum to get sucked in. Long term this can affect hearing by damaging the ossicles or leading to cholesteatoma formation.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: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:Tympanic membrane perforation: not all perforations need to be repaired. Reasons to close a perforation include:Creating a water safe earImprove the patient’s hearingTreat a chronically draining earTympanic membrane retraction: a tympanoplasty may be performed if there is significant retraction of the ear drum in order to prevent future cholesteatoma development or damage to the ossicles. Postoperative considerations:You may or may not have an incision behind your ear. If you do, 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, narcotic pain medications may be required for 2-5 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 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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