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Ear Infections & Surgical Treatment

Chronic Ear Infections

The diagnosis of chronic otitis media (long standing infections of the middle ear) has been determined as the cause of your ear problem. The reason that you have come to Michigan Ear Institute may be due to several factors from the diagnosis of chronic ear infection. This may cause drainage from your ear, hearing impairment, tinnitus (head noise), dizziness, ear pain, or facial weakness. The symptoms that you may be having depend on the extent of the disease and where the disease is located.

Medical Treatment

Medical treatment of chronic ear infections will often control ear drainage. The ear is usually cleaned by the physician in the office using the microscope and suction. Ear drops or creams may be used to eliminate the infection. Oral antibiotics may be necessary in certain cases.

With medical treatment for your condition it is important to have frequent ear exams, especially if your ear is draining. If you have pain in or around the ear, increased drainage, dizziness, twitching or numbness in your face or any other unusual developments, you need to call us immediately.

Surgical Treatment

For many years and still today, surgical treatment has provided successful treatment of chronic otitis media to control infection and prevent serious complications. Advancements of surgical techniques have now made it possible to rebuild the diseased hearing mechanism in most cases allowing improved hearing.

The eardrum may need to be replaced and various tissue grafts may be used to replace it. These include the covering of the muscle from above the ear (fascia) and covering of ear cartilage (perichondruim), or covering from the skull (pericranium). A diseased ear bone may be replaced by an artificial part, a piece of cartilage, or even one of the original hearing bones.

A thin piece of plastic (silastic) frequently is used behind the eardrum to prevent scar tissue from forming and to promote normal function of the middle ear and motion of the ear drum.

When the ear is filled with scar tissue or when all ear bones have been destroyed it may be necessary to perform the operation in two stages. During the first stage of surgery a piece of stiff plastic is inserted to allow more normal hearing without scar tissue. At the second surgery the plastic may be removed. During the operation the area will be examined for recurrent or residual disease and an attempt for restoring hearing is performed. A decision in regards to staging the operation in to two surgeries will be made during the time of the first surgery and is dependent on the findings.

Surgical Outlook

If this is your first operation for a hole in the eardrum, eardrum grafting is successful in over ninety percent (90 %) of the patients resulting in a healed and dry ear.

Hearing improvement following surgery depends on many factors as discussed with your physician.

In most cases two surgeries will be needed in order to improve the hearing. In this case, your hearing may be worse in the operated ear between operations. It is imperative that the second stage operation be performed to rule out the possibility of recurrent or residual disease in the ear. In addition an attempt at improving the hearing function is made.

SURGICAL PROCEDURES FOR CHRONIC EAR INFECTIONS

Myringoplasty

This operation is performed to repair a hole in the eardrum when there is no middle ear infection or disease of the ear bones. This procedure closes the middle ear in a natural way and may improve hearing. Surgery is performed under local or general anesthesia. Tissue grafts are used to repair the defect in the ear drum. The patient may be hospitalized for one night and may return to work within a week. Healing is complete in most cases in eight weeks. At this time the hearing improvement should be noticed.

Tympanoplasty

The purpose of a tympanoplasty is to inspect the ear spaces for disease and to attempt to improve the hearing loss. The operation is performed to eliminate any infection and repair both the sound transmitting mechanism and the eardrum. This surgery may improve the hearing loss. The surgery may be done in one or two stages. A tympanoplasty is an outpatient procedure with some patients going home the same day and some being hospitalized for one night following surgery

Most tympanoplasties are performed through an incision behind the ear, under a local or general anesthetic. The surgery may also be performed through the ear canal. The perforation is repaired with fascia or perichondrium. Sound transmission is accomplished by repositioning or replacing diseased ear bones. Occasionally, a piece of cartilage is used to stiffen the eardrum and attempt to stop recurrent retraction pockets or cholesteatoma.

Mastoidectomy

The mastoid space connects directly with the middle ear space. There are important structures in and adjacent to the mastoid including the brain, inner ear and facial nerve. This makes infections risky and surgery delicate. Almost any active process like infection or cholesteatoma will involve both spaces. Therefore, mastoid surgery is frequently necessary in conjunction with tympanoplasty to adequately treat the existing problem.

The mastoidectomy is the procedure to clean out the mastoid. This is generally done through an incision behind the outer ear. The outer layer of bone is then removed and the abnormal contents are cleaned out. At the completion of the surgery the incision is either glued back together or closed with dissolvable sutures that require little care.

The mastoidectomy with or without a tympanoplasty is an outpatient procedure. One can expect to be discharged after surgery or the next morning. Three weeks of restricted activity are advised. If regular activities require heavy lifting expect three weeks. Most other activities can be resumed sooner.

Mastoidectomy (modified) Radical

The purpose of this operation is to eliminate the infection without consideration of hearing improvement. It is usually performed on those patients who have very resistant infections. Occasionally it may be necessary to perform a radical mastoid operation in cases that originally appeared suitable for a tympanoplasty. The decision is made at the time of the surgery. Fat, muscle or bone graft to the ear is necessary at times to help the ear heal properly.

A radical mastoidectomy is done under general anesthesia and may require one night of hospitalization. The patient may usually return to work in one to two weeks. Complete healing may require up to four months.

Meatoplasty

If a modified radical or radical mastoid is performed the opening to the ear canal sometimes needs to be enlarged by removing a portion of the cartilage in the ear. This is called a meatoplasty. After this procedure is performed, routine cleaning of the mastoid cavity is more easily accomplished.

WHAT TO EXPECT FOLLOWING SURGERY

In most cases you may return to work in a week to ten days. Healing is usually complete in eight weeks, although hearing improvement may not be noted for a several weeks.

There may be some symptoms that may follow any ear operation:

Taste disturbance and mouth dryness

It is not uncommon for there to be taste disturbance and mouth dryness following ear surgery. In some cases the disturbance is prolonged and permanent. This is due to involvement of a nerve that goes through the middle ear with the disease process. It supplies taste sensation to only one part of the tongue.

Tinnitus

Tinnitus (head noise) frequently is present before the surgery and most often is present temporarily after the surgery. It may persist for one to two months and then decrease in proportion to the improvement of your hearing. It may also persist especially if the hearing loss does not improve or worsens. The tinnitus may persist and may become worse.

Ear numbness

Temporary loss of skin sensation in and around the ear is common following surgery. This numbness may involve the entire outer ear an may persist for six months or may be permanent.

Jaw Symptoms

The joint where the jaw is located is located at the front of the ear canal. Some soreness or stiffness in the jaw movement is very common after ear surgery. This soreness or stiffness will decrease and usually go away within one to two months.

Drainage behind the Ear

On occasion the surgeon will need to insert drain tube behind the ear. The need to insert a drain after surgery is usually not apparent before the surgery. Should a drainage tube be needed it will be removed during the post operative phase of healing.

Ear Pressure

Ear pressure or a “popping” sensation or mild equilibrium disturbance may occur from the packing in the middle ear. When the packing is removed post-operatively this sensation will disappear.

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