Ossiculoplasty (Ear Surgery)

OSSICULOPLASTY

An ossiculoplasty is a procedure done to correct any problems with the tiny bones that are responsible for transmitting sound from the eardrum to the inner ear.

INDICATIONS

Reconstruction of the ossicular chain. The chain might be disrupted as a result of chronic otitis media (or its treatment), trauma, or congenital abnormality.

Ossiculoplasty can be carried out alone, or as part of the reconstruction after cholesteatoma excision.

The type of ossiculoplasty relies upon the amount of the ossicular chain remaining. Broadly, the prostheses are classified into total and partial ossicular replacement prostheses (TORPs/PORPs).

PROCEDURE

The middle ear is accessed by one of the above described techniques.

The prosthesis is joined to the remaining ossicular chain. If the prosthesis is approximated directly to the tympanic membrane, a portion of cartilage is used between the two to prevent extrusion.

The tympanic membrane is reconstructed (if required) and replaced.

LENGTH OF PROCEDURE

Variable; usually 1-2 hours.

COMPLICATIONS

Pain

Bleeding

Infection: If BIPP (a bright yellow antiseptic) ribbon is used, it causes a yellow-brown discharge which can be confused for infection.

Hearing loss: As with all middle ear surgeries there is a small risk of hearing deterioration because of manipulation of the ossicular chain.

Prosthesis loosening: This may happen over time in some cases, resulting to deterioration in hearing.  Some patients may therefore need a revision procedure.

Facial palsy: Very rare in only ossiculoplasty.

Taste disturbance: The chorda tympani runs across superior tympanic membrane, and should be recognized and preserved.  Damage can result to a metallic taste, although this normally improves over time.

Tinnitus

Dizziness: Generally, a temporary postoperative effect, but occasionally persists.

Perforation: of the tympanic membrane.

Reaction to BIPP packing: A very uncommon allergic-type reaction to BIPP packing (if used); the patient will have formerly been sensitized by similar packing. The pinna and surrounding soft tissues will become hot and red almost immediately ie within 24-36 hours of the operation, as distinct from a post-operative cellulitis.

Scar (if endaural/postauricular approach used).

POST-OPERATIVE MANAGEMENT

The patient can normally go home the same day. Follow up is normally in 2 weeks for the removal of an ear canal dressing. Inform the surgeon if the patient experiences serious vertigo or sudden severe hearing loss.

TTO

Simple analgesia, and ear-drops if the doctor wishes.

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