Repair of the middle ear

Why is the operation necessary?

Your child may need an operation for the following reasons:

1. To improve hearing
2. To prevent the middle ear from becoming infected
3. To remove cholesteatoma

These are the four operations which are carried out to repair the middle ear:

Myringoplasty

A myringoplasty is to repair a hole in the eardrum

Ossiculoplasty

An operation to correct problems with the tiny bones in the middle ear that are responsible for transmitting sound waves from the eardrum in the inner ear.

Tympanoplasty

An operation to repair the hearing mechanisms in the inner ear; this usually involves repairing a hole in the eardrum and correcting any damage to the tiny bones.

Combined approach tympanoplasty (CAT)

An operation to remove cholesteatoma (abnormal skin growth in the middle ear) from the middle ear and mastoid, as well as removing bone from the mastoid behind the ear canal. This preserves the anatomy of the ear canal.

How does the ear work?

The outer ear collects sound waves, which travel down the ear canal. These make the eardrum vibrate. The vibration is transmitted through the tiny bones (ossicles) in the middle ear, into the inner ear, where it stimulates nerve endings and sends messages to the brain. If the ear is damaged the sounds cannot be transmitted effectively to the inner ear.

Before the operation

Your child will usually be admitted on the morning of the operation. The doctor or nurse will explain the operation in detail and discuss any worries you may have, and you will be asked to sign a consent form. If your child has a temperature or recent signs of infection, the operation may be postponed until they are well.

Before the operation your child should not eat food or drink milk for six hours and two hours before the operation will stop drinking fluid (water).

What does the operation involve?

The operation will be performed under general anaesthetic. The surgeon may use your child’s own tissue or a synthetic material to repair the problem.

The surgeon will make a cut either behind or in the ear canal, to get a good view of the inside of the ear. Tissue from around this area may be used to repair the eardrum. If the tiny bones need repairing it is often necessary to insert a tiny piece of titanium to improve conductive vibrations into the inner ear.

How long will the operation take?

The length of the operation depends on how much needs to be done. It can be between 45 minutes to four hours of operating time; this could increase to five hours for anaesthetic and recovery time. Your child will usually have a large head bandage on, which will stay on until they go home.

After the operation

Your child may be very sleepy at first, this is normal. Your child will be monitored very closely by the nurses for the first few hours. Regular pain killers will be given to ensure your child remains pain free. Once awake your child can start taking sips of water if they feel ready and eat when comfortable. Occasionally children vomit after the operation, but we can give medicines to stop vomiting if necessary. Depending on the extent of the surgery, your child may go home the same day or have to stay in hospital for a night. There may be packing in the ear which may need removing. This will be done in clinic, approximately two weeks after the surgery date. The head bandage will be removed before discharge home.

Possible complications

Surgery on the ear is safe, but every operation has small risks. Bleeding may occur, although this is uncommon.

The graft to the eardrum may not take, or become infected, this may mean that the operation has been unsuccessful and may need repeating.

There is a small risk that surgery could make the hearing worse and very rarely cause dizziness, tinnitus, loss in taste and some damage to the nerve that supplies the muscles in the face, although these risks are below 1%.

Aftercare

Once at home your child should rest for the first two days. They may be more sleepy than usual due to anaesthetic. It is possible they may have a sore throat or sore ears for a few days. Your nurse will advise you about pain relief and how often you should give it. You should give pain relief regularly for the first two days. Your child may need one to two weeks away from school. The packing is likely to stay in for two weeks and the ear will need to be kept dry until then. A slight yellow discharge from the packing is normal; however this should not be pus. No swimming or sports until the doctor has checked the ear in clinic and try to avoid blowing the nose where possible. Flying should be avoided for two months after the surgery.

If you have any concerns about your child please contact ward:………………………………….. where a nurse can advise you.

After 48 hours contact your GP. You should call your GP if:

1. If you notice any discharge from your child’s ear
2. Your child has a high temperature
3. Your child has a severe earache

Hair removal before an operation

The healthcare team often need to remove a little hair from behind the ear to allow them to reach your child’s ear. They will do this by using an electric hair clipper, with a single use disposable head, on the day of the surgery.

Please do not shave the hair yourself, or use a razor for hair removal, as this can increase the risk of infection to the site of the operation.

If you have any questions, please ask the health care team who will be happy to discuss this with you.

Privacy & dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.

References

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)