The ear can be anatomically divided into four sections. The outer ear, the middle ear, the inner ear and the nerve pathways. The most frequent indication for ear surgery is chronic inflammation of the ear with its consequences.
Structure and function of the ear
The ear is anatomically divided into four sections: the outer ear, the middle ear, the inner ear, and the nerve pathways. The outer ear consists of the pinna and the auditory canal, which is separated from the middle ear by the eardrum. The middle ear is a system of air-containing cells and spaces lined with mucous membrane. Its structures include the tympanic membrane, the tympanic membrane with the three ossicles (malleus, incus and stapes), the air-containing spaces of the mastoid process and the tube as a connection to the nasopharyngeal space. The facial motor nerve and the taste nerve run through the middle ear space. The inner ear contains the actual organ of hearing (cochlea) and the organ of balance. From these organs, nerves run to the brain for further processing.
For sound to reach the inner ear, it is transmitted through the ear canal to the eardrum, where it is collected and transmitted through the ossicular chain to the inner ear, where it is amplified (sound conduction). The inner ear contains the auditory cells, which transmit the auditory information via the auditory pathways to the brain (sound sensation).
Reasons for ear surgery
The most common indication for ear surgery is chronic inflammation of the ear with its consequences. The chronic course of inflammation may be caused by repeated acute middle ear infections or by inadequate ventilation of the middle ear spaces. More rarely, a hole in the eardrum, through which foreign substances can repeatedly irritate the sensitive middle ear spaces, causes the chronic process. In other cases, a permanent inflammation of the middle ear with bone involvement (cholesteatoma) forces the patient to undergo surgery.
Furthermore, there are ossification processes of the ossicles (otosclerosis), which can be surgically addressed. The consequences of permanent ear disease can include hearing loss, a "runny" ear, ringing in the ears, dizziness or ear pain. Not all complaints can be remedied surgically. Hearing loss of the inner ear in age-related hearing loss, for example, cannot be improved surgically. Similarly, ringing in the ears cannot be "simply operated away".
Advantages and disadvantages of ear surgery
After ear surgery, there is almost always a marked improvement in the complaints leading to the operation. Normally, the new eardrum heals well. The hearing result is usually satisfactory, but depends on the extent of previous destruction in the middle ear, scarring and ventilation, and can therefore never be predicted with absolute certainty in individual cases. The final hearing result will be seen only after weeks or months.
However, there is no guarantee that the symptoms will disappear. In some cases, an operation must be followed by another one, for example, to further improve hearing or to make repairs to the new eardrum. Extensive diseases and advanced chronic suppurations sometimes make several operations necessary. Hearing loss due to inner ear damage cannot be compensated surgically.
Before the operation – care of the (wet) ear
– never touch the ear canal, especially do not use cotton swabs (Q-tips) – do not stuff absorbent cotton into the ear canal – after showering, blow-dry the ears for about five minutes at arm's length – sufficient hand hygiene and nail care – regular medical treatment – ear conditions as dry as possible before surgery – if the ear is wet and three weeks before a planned surgery, do not wear a hearing aid on the affected ear
The operation
The surgery is performed under general anesthesia. After induction of anesthesia, you will be placed in a semi-sitting position and sterilely draped. The operation takes place under additional local anesthesia through the ear canal, which is widened accordingly. The entire operation is performed under a microscope. The operation can be technically very demanding and often it is only during the operation (after opening the middle ear) that it is possible to decide what measures to take. In addition to the reconstruction of the tympanic membrane with small cartilage strips (palisades), which are removed either behind the ear or in the area of the auditory canal entrance, sometimes parts of the ossicles or, in rare cases, inflamed cells from the mastoid process have to be removed.
In the Department of Otorhinolaryngology, Head and Neck Surgery, the patient's own body material (cartilage, connective tie) is always used to reconstruct the operated spaces. Only in very rare cases the severity of the disease requires the use of artificial material (prostheses).
After completion of the operation, the external incision is sutured and the ear canal is stuffed with a tamponade, which should be left in the ear for two to three weeks (decision by surgeon). In the case of otosclerosis surgery, the duration of the tamponade is significantly shorter. In addition, a prere bandage is applied around the head for two days. If necessary, you will of course receive a remedy for pain or dizziness.
Most patients feel so well after ear surgery that they can leave the hospital two days after the operation, with a few exceptions or those who have had stapes surgery.
Possible complications
The general side effects and risks of any operation are bleeding, infection or wound healing disorders. The special risks of ear surgery are very rare, but may be serious in the case of permanent disturbances.
The facial nerve runs through a bony canal in the mastoid process. Injury to it can lead to temporary or permanent facial expression disorder of the corresponding side of the face. Also, after the operation, there may be a taste disorder on the operated side, which usually disappears by itself after weeks or months. In rare cases, there may be a temporary impairment of the vestibular function with dizziness. Very rarely, hearing may be worse after surgery than before, or may even go completely deaf, or ringing in the ears may occur.
In rare cases, the removal of cartilage behind the ear can lead to an altered position of the auricle.
After the operation
Most patients have hardly any problems due to the ear surgery itself, only the after-effects of the anesthesia such as faintness or general weakness are typical on the first day. There may be head prere due to the bandage or temporary dizziness. Due to the bandage you hear worse on the operated side. Sound sensations like "creaking or chattering" are normal in the operated ear. However, if you feel a great pain, please tell the doctor about it.
On the day you are discharged, you will go home with an ear flap in place. You will be given an appointment to come back to the hospital for ear canal tamponade removal. Please be prepared to be an inpatient again for a few days and bring a hair dryer with you to this appointment.
You will usually wear an ear bandage for two to three weeks. You may sleep quietly on the ear that has been operated on. The head should be kept still for the first three days after surgery. Major physical shocks should be avoided. In the first four weeks after the operation, do not blow your nose, but only "pull up" it. Please open your mouth wide when coughing or sneezing. Do not hold your nose. In addition, you should not engage in sports or expose yourself to major vibrations during this time.
Air travel should not be undertaken for at least three months after surgery (please consult your doctor about this). Please pay attention to whether it "cracks" in your ear when you swallow or yawn (sign of good ventilation) and report this to the treating physician. If there is severe pain in the ear or the ear starts to smell, please report it immediately to the ENT doctor.
Please do not remove the ear bandage on your own and make sure that the bandage does not get damp or wet. Further medical monitoring is required even after discharge. For this, please contact your referring ENT physician. The latter will take over further local banding and decide when the intervals between treatments can be increased or when the treatment is complete. One year after the ear surgery, it is desirable to come back to our clinic for a check-up under the microscope and for a hearing test. Patients with a cholesteatoma (bone erosion) must have regular observation by their established ENT physician and an annual check-up at our clinic, as a cholesteatoma can reoccur even after 20 years.