Chronic otitis media is a persisting or recurring inflammatory condition within the middle ear. Some individuals have an inactive form of chronic otitis media. Resolution of active infection may leave scars, ear drum membrane holes, damage to hearing bones, or other signs of prior disease. A hole in the eardrum membrane (tympanic membrane perforation) may or may not be associated with damage to the ear bones. Damage to hearing bones may also be the result of skull or ear trauma.
Active chronic otitis media implies ongoing drainage through a tympanic perforation. An ear with a simple perforation may become infected because of contamination with water through the ear canal or because of an infection in the mastoid. In some individuals, the eardrum membrane may collapse into the middle ear, draping over the bony anatomy, a condition called atelectasis. Atelectasis may lead to cholesteatoma.
In a normal ear, each swallow opens the Eustachian tube, passing air up into the middle ear. Failure of eustachian tube aeration promotes changes to the lining of the middle ear as well as changes in the mastoid bone. Poorly aerated middle ears more easily develop infection, thick mucus, impaired hearing, ear drum membrane holes, and cholesteatoma, all of which constitute chronic otitis media.
Most active infections with perforations improve with antibiotics. If the tympanic membrane remains perforated despite antibiotic treatment, surgery is often advisable. Repair of the eardrum membrane and hearing bones is called Tympanoplasty. When infection does not resolve with antibiotics, mastoidectomy may be combined with tympanoplasty. Surgery removes diseased tissue, repairs the tympanic membrane, and reconstruct the hearing bones.
Hearing bone reconstruction may be accomplished if infection or trauma has injured the hearing bone. Most commonly, the second hearing bone, the incus, is in need of repair. Replacement of any combination of the three hearing bones may be required.
Many different prostheses are available for hearing bone reconstruction with little scientific evidence that which implant is chosen makes much of a difference in hearing benefit. How the implant is positioned, though, affects hearing and risk of recurrent hole in the ear drum membrane. Typically we use cartilage, remnants of the hearing bones, sometimes in conjunction with specialized plastic hearing bone prostheses.
Care after surgery
Surgery is almost always done as an outpatient. Most patients go home within four to six hours after surgery.
A dressing placed at surgery should not be removed until two days after surgery. A family member may remove the head dressing. Typically, a cotton plug is left in the ear opening cotton and should be left in the ear. Do not clean the ear with a Q-tip. Place the eardrops prescribed at the preoperative visit on top of the ear opening plug, four drops, three times a day. Place a dry cotton ball over the ear packing after using the eardrops. Keep water out of the ear - use a Vaseline - petroleum jelly - soaked cotton ball to plug the ear for bathing. Do not put the ear - head under water until the doctor says the ear is ready.
Usually an incision behind the ear can be washed starting two days after surgery. Pat it dry and coat it with Polysporin, Bacitracin, Neosporin or similar antibiotic ointment after bathing (remember to keep water out of the ear with Vaseline soaked cotton, though.) If the incision becomes red, call the doctor.For any questions or concerns regarding your post-operative course contact us. An answering service should pick the line up after office hours.
No strenuous exercising, and no activities that require severe straining for the first six weeks after surgery. Plan to see the doctor about two weeks after surgery. Plan to return to work after a week if work does not require any heavy lifting or straining. If heavy lifting is necessary at work, stay out of work for at least two weeks. At the two-week postoperative visit, ask the doctor when to return to work. In order to prevent placing any strain on the surgical site, avoid blowing the nose vigorously. Open your mouth and do not pinch the nose for sneezing or coughing.
What to expect after surgery
Some pulsation, popping, clicking and other sounds may occur in the ear. Ear fullness and occasional sharp pain may appear. All of this will go away gradually after surgery. For more annoying pain, use pain medication but only as needed. Use Tylenol or equivalent for less serious pain and stronger pain medicine as prescribed. If the pain medicine fails to relieve pain, notify the doctor.
At two to four months after surgery, the middle ear fluid reaction to surgery gradually clears. The hearing may fluctuate as the ear crackles and pops open. Sometimes, taste disturbance occurs, but usually clears within a few weeks to a few months. It can be permanent, especially if disease surrounds the taste nerve.
Patients sometimes experience dizziness and nausea after cholesteatoma surgery. Some mild unsteadiness and brief dizziness with head turning is not uncommon. If dizziness is marked, do not get up without assistance. If dizziness is present, carefully increase walking every day. Notify the doctor if your dizziness is either marked or worsens. If dizzy, do not drive until quick head turns can be made without disturbing ability to focus. At the time of the post-op visit, ask the doctor when to resume driving.
Some bloody drainage may persist for up to a week or so after surgery. Change the outer ear cotton at least every eight hours. You may initially need to change it more frequently. Notify the doctor immediately if the drainage becomes yellow in appearance, has a foul smell, or if bloody drainage seems excessive. Also notify the doctor if body temperature is greater than 101° F. A short course of antibiotics should be taken per prescription instructions. Always double check for allergies to any medications. Also, notify the doctor promptly for any reaction to the medications that are prescribed.