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PROCEDURE
The disease can be approached via the ear canal (permeatal), or via an endaural incision or a
post-auricular incision. This will be determined by the operating surgeon.
A drill is used to open the mastoid air cells and access the attic (superior middle ear cavity).
Disease is removed from the middle ear cleft. This may entail removal of some of the ossicles,
or drilling out of the mastoid air cells. A cavity is sometimes opened into the ear canal by taking
down the posterior canal wall. Alternatively, the middle ear can also be accessed by raising the
tympanic membrane, with preservation of the posterior canal wall (combined-approach
tympanoplasty).
LENGTH OF PROCEDURE
Variable, from 1-3 hours or more depending on disease extent.
COMPLICATIONS
Pain
Bleeding (rare)
Infection Also quite rare. If BIPP (a bright yellow antiseptic) ribbon is used, this causes a
yellow-brown discharge which can be mistaken for infection.
Residual disease There is always a chance of leaving some disease in the ear. This may
depend on the approach used – combined-approach tympanoplasty may require a second-look
procedure (this may decrease with the advent of advanced MRI techniques).
Recurrence Due to ongoing middle ear disease.
Hearing loss A degree of conductive hearing loss may be inevitable due to the removal of
diseased ossicles. Reconstruction may have limited effect. There is also a small possibility of
complete sensorineural hearing loss.
Facial palsy A facial nerve monitor is generally used. This complication is rare (<1%). A
temporary palsy due to local anaesthetic or contusion/heating of the nerve is more likely than
permanent palsy due to transection.
Taste disturbance The surgeon tries to preserve the chorda tympani. It is occasionally
unavoidably damaged, or may already be damaged by disease. Patients may complain of a
metallic taste postoperatively – this often improves over time.
Tinnitus Usually temporary but rarely long-lasting.
Dizziness Again, usually a temporary postoperative effect.
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POST-OPERATIVE MANAGEMENT
Patients are frequently able to go home the same day. There may be a pressure dressing over
the ear – check the op note for when this can be removed. The ear canal dressing is usually
removed in clinic two weeks later.
Examine the patient for facial weakness prior to discharge. If there is any, inform the operating
surgeon immediately.
TTO
Analgesia is usually the only medication required.