The diagnosis of chronic otitis media (infection of the middle ear) has been established as the cause of your ear problem. Symptoms depend upon whether the condition is active or inactive, whether or not there is involvement of the mastoid bone and whether or not there is a hole in the eardrum. There may be discharge, hearing impairment, tinnitus (head noise), dizziness, pain, or rarely, weakness of the face.

The ear is divided into three parts: the external ear, the middle ear and the inner ear. Each part performs an important function in the process of hearing.

Sound waves pass through the canal of the external ear and vibrate the eardrum which separates the external from the middle ear. The three small bones in the middle ear (hammer of malleus, anvil or incus, and stirrup or stapes) act as a transformer to transmit energy of the sound vibrations to the fluids of the inner ear. VIBRATIONS in this fluid stimulate the delicate nerve fibers. The hearing nerve then transmits impulses to the brain where they are interpreted as understandable sound.

The external ear and the middle ear conduct sound; the inner ear receives it. If there is some difficulty in the external or middle ear, a conductive hearing loss occurs. If the trouble lies in the inner ear, a sensorineural or nerve hearing loss is the result. When there is difficulty in both the middle ear and inner ear, a combination of conductive and sensorineural impairment exists.

Any disease affecting the eardrum or the three small ear bones may cause a conductive hearing loss by interfering with the transmission of sound to the inner ear. Such a hearing impairment may be due to a perforation (hole) in the eardrum, partial or total destruction of one or all of the three little ear bones, or scar tissue.

When an acute infection develops in the middle ear (an abscessed ear), the eardrum may rupture, resulting in a perforation. This perforation usually heals. If it fails to do so, a hearing loss occurs, often associated with head noise (tinnitus) and intermittent or constant ear drainage.

If a perforation is present, you should not allow water to get into your ear canal. This may be avoided when showering or washing the hair by placing cotton in the external ear canal and covering it with a layer of Vaseline. If you desire to swim, use an ear plug to keep water out of the ear. A custom ear plug can be made for you if desired. A tight-fitting bathing cap over the plug adds additional protection. Deep underwater diving should be avoided.

You should avoid blowing your nose in order to prevent any infection in your nose from spreading to the ear through the eustachian tube. Any nasal secretion preferably should be drawn backward and expectorated. If it is absolutely necessary to blow your nose, blow gently and do not occlude or compress one nostril while blowing the other.

Medical treatment is required for ear drainage. A perforated eardrum predisposes the middle ear to infection and so drainage may occur frequently. Antibiotic treatment directly using ear drops or powder in the ear will be required. Antibiotics by mouth may be useful in some cases. The ear will require cleaning by your ear specialist. Never try to clean the ear canal yourself. The outer ear can be cleansed with peroxide if crusting occurs. These measures will usually dry up a draining ear.

Surgery for chronic otitis media is performed primarily to control recurring infection and prevent serious complications (hearing loss, dizziness, facial paralysis, meningitis, abscess formation around or in the brain). Hearing improvement is often a secondary goal of surgery and can be attempted when infection has been cleared.

Reconstruction of the damaged eardrum is usually achieved using tissue that covers a muscle above the ear (fascia). Sometimes tissue that covers cartilage (perichondrium), fatty tissue, or even eardrum transplants can be used. Damaged hearing bones can be replaced with various synthetic "ear bones" or reshaped and repositioned themselves. Cartilage and even transplanted ear bones may also be useful in some cases.

When the ear is severely diseased, it may be necessary to perform the operation in two stages. At the first stage, a piece of stiff plastic is inserted to allow more normal healing without scar tissue. At the second operation, this plastic is removed and we attempt to restore hearing.

Myringoplasty is the operation performed for the purpose of repairing a perforation in the eardrum when there is no middle ear infection or disease of the ear bones. This is a limited procedure that attempts to seal the perforated eardrum.

Surgery is usually performed through the ear canal under local or general anesthesia. Healing is complete in most cases in six weeks, at which time any hearing improvement is usually noticeable. Fatty tissue or synthetic material is used to repair the defect. This is an outpatient procedure. Myringoplasty is a minimally invasive attempt to seal eardrums. Success rates are not as high as with tympanoplasty.

An ear infection may cause a perforation in the eardrum and may also damage the three bones that transmit sound from the eardrum to the inner ear and hearing nerve. Tympanoplasty is the operation performed to repair and inspect the middle ear for disease. This procedure seals the middle ear and improves the hearing in many cases.

Surgery may be performed through the ear canal or from behind the ear, under a local or general anesthesia. The eardrum is reconstructed and any diseased tissue removed from the middle ear. The hearing bones are inspected and repaired if problems are discovered.

In some cases it is not possible to repair the sound transmitting mechanism and the eardrum at the same time. In these cases the eardrum if repaired first, and six months or more later, the sound transmitting mechanism if reconstructed.

This is outpatient surgery and patients may return to work/school after a few days. Healing is usually complete in six weeks. A hearing improvement may not be noted for a few months.

Active infection may in some cases stimulate skin of the ear canal to grow through a perforated eardrum into the middle ear and mastoid. When this occurs a skin-lined cyst known as a cholesteatoma is formed. This cyst may continue to expand over a period of years and destroy the surrounding bone. Serious damage to the hearing and balance systems can occur. If a cholesteatoma is present, the drainage tends to be more constant and frequently has a foul odor. In many cases the persistent drainage is due to chronic infection in the bone surrounding the ear structures.

Once a cholesteatoma has developed or the bone has become infected, it is rarely possible to eliminate the infection by medical treatment. Antibiotics placed in the ear and used by mouth only result in temporary improvement in most cases. Recurrence after treatment has stopped is frequent.

A cholesteatoma or chronic ear infection may persist for many years without difficulty except for the annoying drainage and hearing loss. It may, however, by local expansion and pressure, involve important surrounding structures. If this occurs, the patient will often notice a fullness or a low-grade aching discomfort in the ear region. Dizziness or weakness of the face may develop. If any of these symptoms occur, it is imperative that one seek immediate medical care. Surgery will be necessary to eradicate the infection and prevent serious complications.

When the destruction by cholesteatoma or infection is widespread in the mastoid, the surgical elimination of this may be difficult. Surgery is performed through an incision behind the ear. The primary objective is to eliminate infection to obtain a dry, safe ear.

In most patients with cholesteatoma, it is not possible to eliminate infection and restore hearing in one operation. The infection is eliminated and the eardrum rebuilt in the first operation. This requires a general anesthetic and overnight hospitalization. the patient may usually return to work in several days.

When a second operation is necessary, it will be performed six to twelve months later to restore the hearing mechanism and to reinspect the ear spaces for any residual (remaining) disease. There is a 20% chance of finding additional cholesteatoma at the second operation.

On rare occasions a radical mastoid operation (see below) may be necessary to control infection in a case thought originally to be suitable for tympanoplasty.

The purpose of this operation is to reinspect the ear spaces for disease and to improve the hearing. Surgery may be performed through the ear canal or from behind the ear, under a local or general anesthetic. The ear is inspected for any residual (remaining) disease. Sound transmission to the inner ear is accomplished by replacing missing ear bones with synthetic materials, cartilage or bone.

Surgery is performed as an outpatient. A return to work/school in several days is typical. Healing is usually complete in six weeks. Hearing improvement is frequently noted at that time.

The purpose of this operation is to eliminate discharge from a mastoid cavity and improve hearing.

The operation is performed under general anesthesia through an incision behind the ear. The mastoid cavity may be obliterated with tissue from behind the ear or with bone. At times, the ear canal is rebuilt with cartilage or bone. The eardrum is repaired, and if possible, the hearing mechanism is restored by using synthetic materials, cartilage or bone. In most cases, however, a second operation is necessary to obtain hearing improvement (see Tympanoplasty: Planned Second Stage).

The patient is usually hospitalized overnight and may return to work after one week. Complete healing of the inside of the ear may take several months.

The purpose of this operation is to eradicate the infection or cholesteatoma without consideration of hearing improvement. It is usually performed in those patients who may have very resistant infections. Occasionally it may be necessary to perform a radical mastoid operation in some case that originally appeared suitable for a tympanoplasty. This decision is made at the time of surgery. Tissue grafts from the ear may be necessary at times to help the ear heal properly.

The radical mastoid operation is performed under general anesthesia and requires one to three days hospitalization. The patient may usually return to work in one to two weeks. Complete healing may require up to four months.

The purpose of this operation is to eradicate any mastoid infection and to obliterate (fill-in) a previously created mastoid cavity. Hearing improvement is not considered.

The operation is performed under general anesthesia through an incision behind the ear. A bone or a fat graft from the ear is used to fill in the mastoid space. The patient is usually hospitalized overnight and may return to work in one week. Complete healing may require up to several months.

You will be given an instruction sheet at the time of your preoperative office visit. This will describe proper care of your ear after surgery.

The following is a list of symptoms which may be encountered after surgery.

Taste disturbance is not uncommon for a few weeks following surgery. In 5% of the patients, this disturbance is prolonged.

Tinnitus (head noise), frequently present before surgery, is almost always present temporarily after surgery. It may persist for one to two months and then decrease in proportion to the hearing improvement. Should the hearing be unimproved or worse, the tinnitus may persist or be worse.

Temporary loss of skin sensation in and about the ear is common following surgery. This numbness may involve the entire outer ear and may last for six months or more.

The jaw joint is in intimate contact with the ear canal. Some soreness or stiffness in jaw movement is very common after ear surgery. It usually subsides within one to two months.

Commonly a thin pink discharge will be seen in the ear canal. This is normal, and as time progresses, the discharge will cease.

Fortunately, complications are uncommon following surgery for correction of chronic ear infection.

Ear infection, with drainage, swelling, and pain, may persist following surgery or, on rare occasions, may develop following surgery due to poor healing of the ear tissue.

The primary purpose of surgery in cases of chronic otitis media is eradication of infection or prevention of future infection. We hope to obtain or maintain serviceable hearing in all cases, but this is not always possible.

In 3% of the ears operated the hearing is further impaired permanently due to the extent of the disease present or due to complications in the healing process; nothing further can be done in these instances. On occasion, there is a total loss of hearing in the operated ear.

In some cases a two stage operation is necessary to obtain satisfactory hearing and to eliminate disease. The hearing is usually worse after the first operation in these instances.

Dizziness may occur immediately following surgery due to swelling in the ear and irritation of the inner ear structures. Some unsteadiness may persist for a week postoperatively. On rare occasions, dizziness is prolonged.

Some patients with chronic ear infection due to cholesteatoma have a labyrinthine fistula (abnormal opening into the balance canal). When this problem is encountered, dizziness may last for six months or more.

The facial nerve travels through the ear bone in close association with the middle ear bones, eardrum and the mastoid. An uncommon postoperative complication of ear surgery is temporary paralysis of one side of the face. This may occur as the result of an abnormality or a swelling of the nerve and usually subsides over time without further treatment.

On very rare occasions, the nerve may be injured at the time of surgery or it may be necessary to excise it in order to eradicate disease. When this happens, a nerve graft may be placed to repair the damaged segment. Paralysis of the face under these circumstances might last six months to a year and there would be a permanent residual weakness. Eye complications, requiring treatment by a specialist, could develop.

A hematoma (collection of blood under the skin) develops in a small percentage of cases. Re-operation to remove the clot may be necessary if this complication occurs.

A cerebral spinal fluid leak (leak of the fluid surrounding the brain) is a very rare complication. Re-operation may necessary to stop the leak.

Anesthetic complications are very rare, but can be serious. You may discuss these with the anesthesiologist if desired.

You should have someone drive you from the hospital. Air travel is permissible immediately after surgery. Automobile rides may be uncomfortable, but are not restricted.

If you do not have surgery performed at this time, it is advisable to have annual examinations, especially if the ear is draining. Should you develop dull pain in or about the ear, increased discharge, dizziness or twitching or weakness of the face, you should immediately consult your physician.

If we can be of further help, call or write us at any time.

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