What is
Tympanomastoidectomy?
It is a broad umbrella term for surgery of the tympanic
membrane and mastoid cavity. These types of
procedures are often performed for chronic
infections of the middle ear space and
benign neoplasms such as cholestomas.
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Effects
of Tympanomastoidectomy
Fortunately, most types of ear infections
can be treated. In many cases, a clean safer
ear can be expected. Hearing can also be
improved in many patients depending upon the
severity of disease and the function of the
Eustachian tube.
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Candidates
for Tympanomastoidectomy
When the tube that equalizes pressure in your ear (eustachian
tube) functions poorly due to a cold or
allergy, a vacuum can occur in the middle
ear. This vacuum sucks areas of the eardrum
weakened by repeated ear infections, causing
a pouch or abnormal growth of skin behind
the eardrum. This is actually a growth of
the skin cells of the eardrum collecting and
forming what is called a cholesteatoma. This
growth can damage any bone that is near if
not treated, causing dizziness, facial nerve
damage, deafness, an infection in your
brain, or even death. You may need to have
surgery to remove the growth or infected
bone from your ear.
Ear infections are one of our most common
ailments. 3 out of every 4 of children in
America will have at least one ear infection
before growing up. Infections in adults are
much less common. When they occur, they are
often in people who've had many infections
in childhood or who have other causes for
ear congestion such as cigarettes, allergies
or the common cold. In fact, congestion of
the ear is the cause of most infections. The
ear ordinarily receives ventilation by the
Eustachian tube which is a natural
connection between the ear and the nose and
throat.
Warning signs of COM include the following:
·
persistent blockage or fullness of the ear
·
chronic ear drainage
·
development of balance problems
·
facial weakness
·
persistent deep ear pain
COM generally occurs gradually over many
years in patients with long standing or
frequent ear trouble. However, it can
occasionally develop over several months in
a patient with no previous history of ear
disease.
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Your
Consultation
The first step in treating COM is to have a
complete ear examination by an
otolaryngologist, a physician who
specializes in the medical and surgical
treatment of the ear, nose, and throat.
Treatment of COM depends upon the stage of
the disease. Initially, efforts to control
the causes of eustachian tube obstruction,
such as allergies or other head and neck
infectious problems, may prevent progression
of COM. This is the reason many children
with chronic eustachian tube problems have
ventilation tubes inserted in their eardrums
to allow normal airflow in the middle ear
until they outgrow the eustachian tube
problems.
Once the disease has progressed to the point
of significant middle ear damage to the
eardrum or ossicles, more intensive
treatment is needed. If active infection is
present in the form of ear drainage,
antibiotic ear drops are prescribed.
Occasionally, these may be supplemented with
oral antibiotics.
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The Tympanomastoidectomy
Procedure
Once the active infection is controlled,
surgery is usually recommended. There are
three objectives of surgery for COM:
·
eradication of the disease
·
preservation or improvement in hearing
·
remodeling of the middle ear and mastoid
bone, located just behind the external ear,
to prevent recurrence of the disease
Surgery to achieve these objectives is
called tympanomastoidectomy. The
otolaryngologist first makes an incision
behind or around the upper portion of the
external ear. Part of the mastoid bone is
then drilled away to gain access to the
middle ear space. Finally, the abnormal
tissues are removed. If possible, efforts
are made to rebuild the eardrum and the
sound conducting bones. It is sometimes
necessary, however, to complete the hearing
reconstruction at a later date rather than
at the same time as removal of the infected
or damaged parts.
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Recovery
You will wake up in the recovery room after
your surgery where you will be monitored by
the nurses and anesthesiologist. You should
be able to go home the same day as your
surgery. You will have stitches behind your
ear covered with steri strips that will need
to be kept on your ear until you come in for
your two-week appointment when a nurse will
remove them for you. You will then come back
two weeks later to have packing removed from
the inside of your ear by your surgeon. You
should have little or no pain following
surgery. You should also have little or no
bleeding following surgery; you should not
have any fever and little or no nausea and
vomiting.
You will need to avoid getting your ear wet
following surgery. Keep the dressing on
until you are seen by your physician. Your
physician may prescribe drops to be used
after the dressing is removed. At least 3
or 4 visits are necessary for appropriate
follow up over several months following
surgery.
Patients will have the ear bandaged for a
week or two. It takes several months for
complete healing and the hearing results may
continue to improve throughout the healing
phase. Routine checkups by the
otolaryngologist are recommended at least
yearly after the healing is complete and in
some cases may be required two or more times
yearly to maintain adequate local hygiene
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Risks
Some of the possible risks and complications of a
Tympanoplasty are infection, the graft not
holding and exposing the hole in the
eardrum, further hearing loss, ringing in
the ears, dizziness or facial nerve damage
or numbness in the outer ear. Also you may
experience dry mouth or notice a change in
your sense of taste.
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Frequently Asked
Questions
Q: Why do I need surgery?
A:
When the tube that equalizes pressure in
your ear (eustachian tube) functions poorly
due to a cold or allergy, a vacuum can occur
in the middle ear. This vacuum sucks areas
of the eardrum weakened by repeated ear
infections, causing a pouch or abnormal
growth of skin behind the eardrum. This is
actually a growth of the skin cells of the
eardrum collecting and forming what is
called a cholesteatoma. This growth can
damage any bone that is near if not treated,
causing dizziness, facial nerve damage,
deafness, an infection in your brain, or
even death. You may need to have surgery to
remove the growth or infected bone from your
ear.
Q: What happens during surgery?
A:
Under general anesthesia your surgeon will
make an incision behind your ear so that the
inside of your ear can be reached. Any
growth or infected bone is then removed.
Packing will be placed in your ear to help
promote healing. The incision site is then
closed with stitches and covered with steri
strips or tape. This surgery is usually done
in about one-and-a-half to three hours so
you should be able to go home the same day
as your surgery.
Q: Do I have to keep water out of the ears?
A: Yes. Avoid water in the ears
until the physician indicates it is safe to
allow water.
Q: How much pain should I expect?
A: Typically, this is not very
painful following surgery. The pain is well
controlled with pain medication that will be
prescribed.
Q: What should I expect after the surgery?
A: Your hearing may be decreased
while packing is in the ear. You may also
have some dizziness temporarily and so you
should take extra precautions.
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