Tympanic menbrane perforation and Ossicular chain destruction
REASONS:
1 : Recurrent otitis in childhood
Trans-tympanic aerator has a fundamental role in prevention of recurrent otitis. Such centers of infection like tonsils and adenoids should also be examined by a doctor and treated. Sometimes, it`s necessary to remove them because of the interaction between the adenoids, the tonsils and the middle ear.
2 : Trauma
The most common reason is the trauma inflicted by a cotton swab or a slap to the ear.
In case of tympanic membrane perforation, the diagnosis is established on the base of the clinical examination data (the ear is examined under microscope or endoscope, the photos of tympanic membrane are taken), hearing examinations (acoumetry, audiometry, impedancemetry) will show the importance of hearing loss. CT or MRI might be necessary to determine the associated lesions.
TYMPANIC MEMBRANE PERFORATION :
The tympanic membrane is a round membrane, up to 1 cm in diameter, which separates the external auditory canal from the middle ear.
Depending on its size, the perforation can be partial of subtotal.
The repair of tympanic membrane perforation is done with the use of graft made out of tragus cartilage or perichondrium.
OSSICULAR CHAIN DESTRUCTION :
It can be seen through the tympanic membrane. We frequently encounter it with the patients who suffer from pronounced hearing loss, confirmed on audiometry. CT-scan will help to visualize it. The long limb of incus is the most fragile ear bone. Thus, it`s frequently touched and damaged.
During surgery it`s preferable to perform the reparation with the incus, changing its position to restore hearing. If the destruction of incus is already too important and it`s impossible to use it, an adapted ossicular prosthesis will be put in place.
10 years after the transposition of the incus :
CHOLESTEATOMA :
Cholesteatoma – is a particular aggravated form of chronic otitis which is followed by lesion of the ossicles. Its treatment can be only surgical even in a period of infection.
It`s an active pathology.
Cruveilhier called it the white tumor or the dangerous chronic otitis as it caused a number of complications - facial paralysis, vertigo, hearing loss, brain abscess. Nowadays the last one is a rare complication due to its early diagnostics.
The cholesteatoma can inflict lesion (destruction) of the bones. It can uncover the anatomical structures which are generally well protected (the facial nerve, the internal ear and the brain)
It must be surgically removed.
In order to prevent cholesteatoma recurrence, it`s essential to preserve or to reconstruct the osseous wall, separating the external auditory canal from the middle ear cavity because the cholesteatoma itself consists of epithelium trapped within the middle ear space from the auditory canal.
MIDDLE EAR SURGERY :
If the tympanic membrane perforation is small, the surgery can be done under local anesthesia under endoscopic control. In case of chronic otitis, the surgery must be done under general anesthesia under endoscopic control with the use of microscope.
All ear surgery with the use of microscope is done under general anesthesia; sometimes neuromonitoring system is utilized to ensure the integrity of the facial nerve.
The duration of surgery is different in each particular case:1 hour to restore the tympanic membrane or one of the auditory ossicles (simple tympanostomy); 2:30 – 3 hours to remove the cholesteatoma, sometimes longer, depending on the extent of the lesion (reconstruction or rehabilitation of the middle ear).
When the surgery is completed, the ear canal is packed with dressing material; a protective bandage, covering the ear pavilion, will be removed in a week.
You are able to return home on the following day after surgery. You will be recommended a course of treatment with antibiotics.
In a week after surgery the bandage will be removed, the surgeon will control the ear under microscope.
The next follow-up visit will be recommended in 7 days to control the correct healing.
You will be recommended to avoid swimming and going to sauna for one month. In case of necessity, you can take plane 10 days after surgery if you have the possibility to visit a doctor for control in your hometown.