Ossicular Chain Reconstruction
The middle ear is located behind the eardrum, or tympanic membrane, and contains three bones known as ossicles. These ossicles help to conduct and amplify outside sound to the inner ear. Damage or discontinuity in the ossicles results in hearing loss. Damage can result from many different processes, including chronic infections, trauma, and tumors/masses such as cholesteatoma. Repairing the ossicular chain is done either with synthetic prosthetic grafts or by using the
The procedure for ossiculoplasty takes place under general anesthesia and takes approximately one to two hours. This is done either by itself or in conjunction with other procedures including mastoidectomy and ossicular chain reconstruction. An incision is made behind the ear to access the ear canal. The eardrum, or tympanic membrane, is carefully elevated from the surrounding canal, and the ossicles are carefully examined and palpated. If the ossicles appear to be in good condition, one of the ossicles be removed, sculpted into proper shape, and repositioned to reestablish an intact ossicular chain. If this is not possible, a synthetic prosthesis is used to reestablish the ossicular chain. The prosthesis or resculpted ossicle is held in place by a supporting layer of absorbable gelatin sponges placed in the middle ear. The tympanic membrane is then placed back into its proper position. The incision behind the ear is then sutured closed.
After spending several hours in the recovery area, you will be discharged home. Pain associated with the procedure is typically mild, and is resolved by taking the prescribed pain medications. You will remove the ear cup dressing the next morning. Do not be concerned regarding your hearing during the healing process. It takes 6 - 8 weeks before we can evaluate improvement and your hearing will be tested at that time. Bloody drainage from the incision area may occur during the first 1-2 days. Call the office if this persists longer than 2 days or if the incision site develops an odor, swelling, or pain. Water should be kept out of the ear until it is healed. You may take a shower 4 days after the surgery provided you cover the ear canal opening with a cotton plug soaked in ointment. Do not blow your nose for 4 weeks. If you sneeze, do so with your mouth open. Ear drops should be used as prescribed. No bending, lifting, straining aerobic exercise, heavy work or traveling until approved by your surgeon. DO NOT USE ASPIRIN OR IBUPROFEN PRODUCTS FOR 2 WEEKS BEFORE AND 1 WEEK AFTER SURGERY. No flying or changes in altitude until cleared by your surgeon.
Risks of Surgery
There are several risks associated with ossiculoplasty. Though the success rate of surgery is high (>90%), there is a risk of unchanged hearing or worsened hearing due to ossicle or prosthesis movement. If this occurs, revision surgery may be necessary. In cases where the tympanic membrane is intact, there is small risk of a perforation developing in the eardrum as a consequence of the operation. If this occurs, an adjunctive procedure may be necessary. Another risk is alteration in taste. This can occur because the nerve which is responsible for taste on that side of the tongue runs on the undersurface of the tympanic membrane and may be damaged from the perforation. The taste loss is usually temporary and typically recovers after several weeks. Another risk is some unsteadiness following the surgery, which may last up to six months; in rare cases it is a permanent condition. Damage to the facial nerve, which controls movement on that side of the face, is a very slight risk of this surgery. This can result in facial weakness; when this occurs, it is usually temporary and typically recovers after several weeks, but occasionally can be permanent. The incidence of postoperative infection is less than 5%. Infections are usually successfully treated with antibiotics. Postoperative bleeding can usually be controlled by packing or a tight dressing but, occasionally, a second operation is required.