Tympanoplasty – Ear Tube Surgery
Ear tube insertion is the placement of tubes near a child’s eardrums. It is done to allow the fluid behind a child’s eardrums to drain so that the ears can function normally.
While the child is under general anesthesia (asleep and not able to feel pain), a small surgical cut is made in the eardrum. The built-up fluid is suctioned out through this cut. Then, a small tube is inserted through the eardrum. The tube allows air to flow in and fluid to constantly flow out of the middle ear.
Ear tube insertion may be recommended when fluid builds up behind your child’s eardrum and does not go away after 4 months or longer. Fluid buildup may cause some hearing loss while it is present. But most children do not have long-term damage to their hearing or their ability to speak even when the fluid remains for many months.
An ear infection is another reason for inserting an ear tube. If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the doctor may recommend ear tubes.
Ear tube insertion is also used sometimes for people of any age who have:
- Barotrauma (pressure injury) from flying or deep sea diving
- Hyperbaric oxygen therapy
- A complication from a severe ear infection, such as mastoiditis, brain infection, meningitis, or facial nerve paralysis
Your child’s ear specialist may ask for a complete medical history and physical exam of your child before the procedure is done.
Always tell your child’s doctor or nurse:
- What drugs your child is taking. Include drugs, herbs, and vitamins you bought without a prescription
- What allergies your child may have to any medicines, latex, tape, or skin cleaner
On the day of the surgery:
Children usually stay in the recovery room for a short time and leave the hospital the same day the ear tubes are inserted. Your child may be groggy and irritable for an hour or so as they awaken from anesthesia. Your child’s doctor may prescribe ear drops or antibiotics for a few days after the surgery.
Most children can return to normal activities the day after the surgery.
Some ear specialists will recommend earplugs or swimmer’s headbands while swimming or bathing to keep water out of the ears. If earplugs are not recommended for these activities, they may be recommended for diving in deep water. Check with your ear specialist.
The surgical cut heals on its own, without stitches. The hole closes, and the ear tubes usually fall out on their own after 14 months or so.
After this procedure, most parents report their children have fewer ear infections, recover fast from infections, and that they worry less about whether their child has ear infections.
If the tubes do not fall out on their own, an ear specialist may have to remove them. If ear infections return after the tubes fall out, another set of ear tubes can be inserted.
Stapedectomy for Otosclerosis
Stapedectomy is a surgical procedure in which the innermost bone (stapes) of the three bones (the stapes, the incus, and the malleus) of the middle ear is removed, and replaced with a small plastic tube of stainless-steel wire (a prosthesis) to improve the movement of sound to the inner ear.
A stapedectomy is used to treat progressive hearing loss caused by otosclerosis, a condition in which spongy bone hardens around the base of the stapes. This condition fixes the stapes to the opening of the inner ear, so that the stapes no longer vibrates properly; therefore, the transmission of sound to the inner ear is disrupted. Untreated otosclerosis eventually results in total deafness, usually in both ears.
What to expect
With the patient under local or general anesthesia, the surgeon opens the ear canal and folds the eardrum forward. Using an operating microscope, the surgeon is able to see the structures in detail, and evaluates the bones of hearing (ossicles) to confirm the diagnosis of otosclerosis.
Next, the surgeon separates the stapes from the incus; freed from the stapes, the incus and malleus bones can now move when pressed. A laser (or other tiny instrument) vaporizes the tendon and arch of the stapes bone, which is then removed from the middle ear.
The surgeon then opens the window that joins the middle ear to the inner ear and acts as the platform for the stapes bone. The surgeon directs the laser’s beam at the window to make a tiny opening, and gently clips the prosthesis to the incus bone. A piece of tissue is taken from a small incision behind the ear lobe and used to help seal the hole in the window and around the prosthesis. The eardrum is then gently replaced and repaired, and held there by absorbable packing ointment or a gelatin sponge. The procedure usually takes about an hour and a half.
Good candidates for the surgery are those who have a fixed stapes from otosclerosis, and a conductive hearing loss at least 20 dB. Patients with a severe hearing loss might still benefit from a stapedectomy, if only to improve their hearing to the point where a hearing aid can be of help. The procedure can improve hearing in more than 90% of cases.
The patient is usually discharged the morning after surgery. Antibiotics are given up to five days after surgery to prevent infection; packing and sutures are removed about a week after surgery.
It is important that the patient not put pressure on the ear for a few days after surgery. Blowing one’s nose, lifting heavy objects, swimming underwater, descending rapidly in high-rise elevators, or taking an airplane flight should be avoided.
Right after surgery, the ear is usually quite sensitive, so the patient should avoid loud noises until the ear retrains itself to hear sounds properly.
It is extremely important that the patient avoid getting the ear wet until it has completely healed. Water in the ear could cause an infection; most seriously, water could enter the middle ear and cause an infection within the inner ear, which could then lead to a complete hearing loss. When taking a shower, and washing the hair, the patient should plug the ear with a cotton ball or lamb’s wool ball, soaked in Vaseline. The surgeon should give specific instructions about when and how this can be done.
Usually, the patient may return to work and normal activities about a week after leaving the hospital, although if the patient’s job involves heavy lifting, three weeks of home rest is recommend. Three days after surgery, the patient may fly in pressurized aircraft.
A mastoidectomy is surgery to remove cells in the hollow, air-filled spaces in the skull behind the ear. These cells are called mastoid air cells.
The surgery used to be a common way to treat an infection in the mastoid air cells. Such infection usually resulted from an ear infection that spread to the nearby bone in the skull.
Mastoidectomy is now rarely needed, because infections are commonly treated with antibiotics.
However, this surgery may be used to treat other problems, such as:
- Complications of an ear infection (otitis media)
- To place a cochlear implant