Otitis Media (middle ear infection)

Perforation of Ear Drum

The ear drum and middle ear can become diseased. This is usually due to infection. This may occur after a cold / nasal infection. This can result in a perforation or retraction (an ear drum that folds inward) of the ear drum. Perforations usually heal but on occasions they do not and can become repeatedly or chronically infected. This can cause damage to the ear resulting in hearing loss. Infections can sometimes be treated with antibiotic ear drops. The ear can however become re-infected later.

Perforation of Ear Drum:
diseased ear myringo tympanoplasty schematic copy

If the perforation does not become infected agin there is the option to leave the perforation alone. In some case (usually due to infection) an operation is carried out to repair the ear drum and or any damage to the small bones in the middle ear. The operation is called a myringoplasty or tympanoplasty.

Myringoplasty/Tympanoplasty Operation

A general anaesthetic is required. A cut is made in front or behind the ear and the ear drum lifted. A graft is taken from the tissue underneath the skin or from the cartilage of the ear and used to close the hole. If there is damage to the small bones in the middle ear these can be repaired or replaced with artificial bone. Packing is placed in the ear. This will requires removal in clinic 2 to three weeks later. The skin is usually closed with dissolving stitches which do not require removal and a head bandage applied overnight. The operation can take 1 to 2 hours. There is some pain in the ear after the operation which can be controlled with painkillers.

There is an 85% chance of obtaining a dry infection free ear. When the ear drum alone is repaired the hearing will usually improve only slightly. If the bones in the ear are damaged and are repaired the hearing usually improves.

Possible complications of surgery

Hearing loss

In a small proportion of patients hearing loss due to inner ear damage may occur.  This may be complete deafness on the operated side and may be permanent.  Occasionally hearing does not change.

Dizziness

It is common to be slightly dizzy after surgery but on rare occasions especially if the inner ear is damaged the dizziness can be prolonged.

Tinnitus

Some patients develop ringing in the ear. This is more common if the inner ear is damaged.  Usually this is temporarily that it may be long-term.

Facial weakness (facial palsy)

The nerve which control the muscle of the face runs through the ear and can on the very rare occasions be damaged resulting in paralysis of the face on the operated side.

Other complication include: infection, bleeding, altered taste, pain and numbness around the ear. These all generally improve in due course.

After the operation

Most patients can go home on the day of surgery or the day after the operation. The ear will discharge a little. You can change the cotton wool on the outer ear as required. The packing in the ear may be dissolvable or it will need to be removed in clinic. If any of the packing comes out, cut the part hanging out and tuck the rest in to the ear. If the piece of packing comes out completely, leave it out. (There will be a second piece inside.) Try not to get your ear wet especially during the first two days after your operation. Use cotton wool smeared with Vaseline to plug the outer ear when having shower.

If the ear becomes more painful and swells you may have an infection. Contact the ENT ward or if more convenient your General Practitioner.

Patients need 1 to 2 weeks off work/school.

Cholesteatoma

If the ear drum becomes severely retracted the dead skin on the surface of the ear drum can not migrate out as it normally does resulting in a cholesteatoma. This is a collection of infected dead skin and can slowly enlarge damaging the middle ear resulting in hearing loss. On rare occasions the inner ear or facial nerve or brain can be damaged/infected by the disease resulting in complete deafness, tinnitus (ringing in the ear), dizziness, weakness in the muscle of the face (facial palsy) or infection of the brain.

diseased ear schematic copy

Once cholesteatoma is established surgery (mastoidectomy) is the only reliable method of treating the disease.

Mastoidectomy

A general anaesthetic is required. A cut is made in front or behind the ear and the mastoid bone (the bone behind the ear) is operated on, usually with a drill to remove the cholesteatoma. The mastoid bone is partially reconstructed with cartilage graft. Packing is placed in the ear and a head bandage applied overnight. The packing will require removal in clinic three weeks later. The skin is usually closed with dissolving stitches which do not require removal. The operation can take 2 to 3 hours. There is some pain in the ear after the operation which can be controlled with painkillers.

There is an 80% chance of obtaining a dry infection free ear. The hearing can occasionally be improved.

Possible complications of surgery include:

Hearing loss

In a small proportion of patients hearing loss due to inner ear damage may occur. Occasionally the disease has eroded in to the inner ear and on removal of the diseased area the inner ear gets damaged.

Dizziness

It is common to be slightly dizzy after surgery but on rare occasions especially if the inner ear is damaged the dizziness can be prolonged.

Facial weakness (facial palsy)

The nerve which control the muscle of the face runs through the ear and can on rare occasions be damaged resulting paralysis of the face on the operated side.

Tinnitus

Some patients develop ringing in the ear. This is more common if the inner ear is damaged.

Rarely the dura (the lining around the brain) can be damaged and CSF (the flu die around the brain) can leak into the ear. This can in very ere case lead to meningitis. Often the problem sort itself out but occasionally further surgery is required.

Other complication

Infection, bleeding, altered taste, pain and numbness around the ear. These all generally improve in due course.

After the operation

Most patients can go home on the day of surgery or the day after the operation. The ear will discharge a little. You can change the cotton wool on the outer ear as required. The packing in the ear may be dissolvable or it will need to be removed in clinic. If any of the packing comes out, cut the part hanging out and tuck the rest in to the ear. If the piece of packing comes out completely, leave it out. (There will be a second piece inside.) Try not to get your ear wet especially during the first two days after your operation. Use cotton wool smeared with Vaseline to plug the outer ear when having shower.

If the ear becomes more painful and swells you may have an infection. Contact the ENT ward or if more convenient your General Practitioner.

Patients need 1 to 2 weeks off work/school.