The surgery of the middle ear includes the surgical maneuvers destined to recover the system of transmission of sound of the ear. This function is performed through the eardrum and three ossicles; the hammer, the anvil and the stirrup.
The cause that usually produces the disruption of this chain are old infections that leave as a sequelae a perforation in the eardrum or the erosion in part of the ossicles , with the consequent loss of hearing.
If the infection is still patent and the ear oozes recurrently, the earliest will be the healing of the ear , either with antibiotics or surgery.. If surgery has been opted for, it is possible that in the first operation the integrity of the chain is not reconstructed and a second reconstructive surgery must be performed.
Another situation that occurs without previous infections is the loss of mobility of the last of the ossicles; the stirrup. In this case we are facing a disease that we call otosclerosis . This process, like the previous thing, leads to a hearing loss.
The ways of access to the ear are through the canal itself or through retroauricular through an incision in the fold behind the ear. It will depend, in any case, on the location of the perforation.
In cases in which the problem is that the eardrum is perforated but the ossicles are intact, it is reconstructed with a graft obtained from the fascia of the temporal muscle or with the perichondrium of the cartilage of the pavilion.
In those cases where there is also disruption of the ossicles chain, a reconstruction of the same is intended. We can use different structures for this. Even so, the most used are the remains of the bone chain , which are remodeled and adapted to the new situation. It can also be done with the cartilage of the ear or by synthetic prostheses.
In the case of otosclerosis, we perform an operation called stapedectomy or stapedotomy , which consists in replacing the stapes by a synthetic prosthesis that anchors in the anvil and transmits the sound wave to the inner ear.
Like any surgery, it can lead to some complications, such as a hemorrhage or an infection. In addition, it may be that the eardrum grafts are not revascularized and necrotic, which would lead to another residual perforation .
Another possible complication is that the reconstruction of the ossicles is not effective and therefore we do not improve the hearing. To this end, it is very important the preoperative assessment in consultation and explain to the patient realistically what are the true possibilities of recovery. In cases of otosclerosis, recovery is expected to be complete and immediate.
In addition, we must bear in mind that whenever the middle ear is operated there is a certain possibility, although little, of injuring the facial nerve , which is responsible for the mobility of the face. Any patient who is going to have an intervention in the middle ear should be explained this remote situation.
It is frequent the appearance of some type of dizziness , which in any case will disappear in a few hours or days. The loss of more hearing than we previously had is unlikely although possible.
The postoperative period is not painful or uncomfortable. Depending on the access route to the middle ear, there will be stitches in the retroauricular fold and a plug in the ear.
In cases in which we replenish the ossicles or stapedectomy chain, rest will be recommended during the first few days to prevent reconstruction from being mobilized.
The cap is usually kept for at least a week and then the patient will be summoned in consultation to remove it while the incision points are removed. After the removal of the plug, it is possible that there are still blood clots that impede the correct mobility of the new chain so that the recovery of the hearing can be delayed for a week.
Normally oral antibiotics are also prescribed that try to prevent the grafts from becoming infected and analgesics.