118 - Otologic surgery

Summary

Otologic surgery encompasses a wide variety of surgical procedures involving the ear with the goal of eliminating infection and/or restoring hearing. Chronic drainage from the ear suggests a tympanic membrane perforation or cholesteatoma (benign squamous keratocyst) of the middle ear or mastoid. Tympanoplasty (repair of tympanic membrane perforation) usually uses autologous temporalis fascia or perichondrium and may be combined with mastoidectomy, of which there are two types, when inflammatory disease or cholesteatoma extends into the mastoid. In canal-wall-up mastoidectomy, the external auditory canal is kept intact and the mastoid cavity drains through the middle ear as is normally the case. Canal-wall-down mastoidectomy is used for more severe disease and exteriorizes the mastoid cavity through an enlarged external meatus.

Reconstructive surgery for hearing – ossicular reconstruction and stapedotomy – is used when trauma, infection, or otosclerosis (stapedotomy) has damaged the middle ear sound conductive mechanism.

Otologic procedures may be performed under general anesthesia or local anesthesia with sedation. Muscle relaxants are avoided if cranial nerve monitoring is needed intraoperatively. Most otologic procedures are accomplished in one to four hours. Significant blood loss and/or transfusion are not expected.

Usual postoperative course

Expected postoperative hospital stay

Most otologic surgery is performed as an outpatient or ambulatory inpatient procedure with 23-hour observation.

Operative mortality

Equals the anesthetic risk.

Special monitoring required

Since the surgical field is in close proximity to the facial nerve, muscle relaxants are avoided so that facial activity may be monitored intraoperatively.