General Information about Ear Surgery

Before the operation

Your procedure will have to be scheduled at least 1 week before the actual surgery date. You'll be asked to have a general physical examination by your primary care doctor. Your primary doctor will likely need to obtain blood tests, EKGs or other tests.

Some patients also need specialized CT scans of their ear prior to their surgery. Your doctor may discuss this with you. The evening before the surgery, you will need to wash with a special soap to clean your hair and ear. Do not let the soap get in your eyes. Rinse the area thoroughly following the use of the soap.

Do not eat or drink anything after midnight before your operation. If you do, it will delay or possibly cancel your surgery. Some medications may not be taken prior to the day of surgery. Please discuss this with your primary care doctor.

Risks, benefits and alternatives to the surgery

Your doctor will discuss the details of your surgery with you during your clinic visit. This discussion will include the reasons why the surgery is being recommended as well as what may happen if you decline to have the surgery and if there are any alternatives to surgery. The risk of ear surgery includes three major issues. First, there is a chance that the hearing in the operated ear will be worse following the operation. Hearing improvement is often a goal of surgery, but sometimes that is a secondary goal. The primary goal of ear surgery is always to make the ear a safe ear. Some individuals may experience a significant increase in their hearing loss and a few individuals may lose all of their hearing in the operated ear which may not be correctable. Everyone who undergoes surgery in the ear has an increase chance of hearing loss immediately following the operation. Frequently, the ear canal is packed with a material to help the eardrum and ear canal heal. In almost all cases, blood and fluid from the surgery will collect in the middle ear and prevent the normal conduction of sound into the inner ear. This will lead to a temporary hearing loss. Second, most patients experience some feeling of unsteadiness, nausea and vertigo. This feeling usually goes away in a few hours. A small number of patients may have to be admitted to the hospital because their symptoms are severe. An even smaller number of individuals may have permanent problems with dizziness and vertigo. Finally, there are 2 nerves that run through the middle ear. One nerve conducts taste from the tongue back to the brain. Sometime that nerve may be stretched during the surgery or it may even need to be cut. Many individuals experience a metallic taste or a change in their taste following the operation. Usually this problem goes away after several months. The second nerve in the middle ear is the facial nerve. This nerve moves the face. It enables the patient to elevate the eyebrow, smile, and pucker their lips. Injuries to this nerve are uncommon. When they do occur, they are usually temporary. A small number of individuals may have permanent facial weakness following ear surgery. Usually there are many things that can be done to alleviate the situation, but no one can guarantee that they will always work. Minor risks include infection, bleeding and a hole in the eardrum after surgery. The chances of all of these risks are very small. Ask any questions you have about the surgery during your visit. And, if there are questions you think of later, you should contact your doctor and he/she will answer them.

The day of surgery

You will be asked to sign a written consent form stating that your doctor has discussed the operation to be performed and that you agree to the procedure. Be sure to ask your physician any questions before you receive any medications from anesthesia. Many ear procedures are performed under general anesthesia. A doctor specializing in anesthesia visits before your operation. They will ask questions about your medical history and give you a brief examination. They will also discuss what will be done during your operation to keep you comfortable. Most individuals will not remember anything about their surgery. Make sure that a family member or friend is able to take your personal items. These may include hearing aids, glasses, rings and other items that you have with you. Also make sure that a family member or friend is available to take you home if it is a same-day surgery.

After surgery

After your operation you'll go to the recovery room to wake up before returning to the pre-surgery waiting area. Most of the time, a large bulky dressing is placed over the ear. This dressing has a Velcro strap which keeps it tight. The dressing should be somewhat uncomfortable but should not cause intense pain. If you wear glasses, it will likely be necessary to remove the ear piece on the surgical side so that it will fit over the dressing. You may need to keep the ear piece off and tape the glasses to your forehead while the ear heals. The head of your bed should be elevated for several days following the operation to prevent swelling and drainage. If you have pain, let the nurse know immediately so that pain medications can be given. It is important for you to take deep breaths and to clear your lungs. Do not get out of bed for the first time without a nurse in the room. Your sense of balance is likely to be involved and you may be unsteady on your feet.

Activity

It is important to limit certain activities for several days to weeks following the surgery. If you have questions about any of these issues please contact your physician. Sneeze with your mouth open. This prevents the buildup of pressure in your middle ear. You should not blow your nose for the same reason. You can gently dab your nose or sniff to draw mucus to the back of your throat. Do not lift anything heavy. Anything that would make you strain should be avoided for at least the first 1 to 2 weeks following the operation. Do not move rapidly. Discuss flying with your physician. Some individuals can return to normal flight activities shortly after the procedure. Most doctors request that you not use air travel for a period following the operation. You can expect discomfort following the operation. Pain medication should be available from your physician so that you do not have significant problems. It is important for patients to take the pain medication early when they begin to experience pain. You should follow the instructions on the medication carefully. Take the medication on schedule. Waiting too long reduces the effectiveness of the drugs. Many people are interested in when they can return to driving. You should not drive if you are still taking narcotic pain medications. Driving a motor vehicle is an individual decision. Patients should try a simple test before they begin operation of a motor vehicle. When sitting in the driver's seat, the patient should look in all of the mirrors then turn around and look behind the car as though you were backing up. Following these movements the patient should look straight ahead and then down at this speedometer. He should be able to read the numbers on the odometer and not experience dizziness. The patient should also be able to apply the brake with force without fear of pain. If you can accomplish all of these things, it is likely that you're prepared to drive again. Be cautious. Do not attempt to drive at high rates of speed or under challenging conditions the first time out. Individuals should try short local trips with someone available to help.

Care of the ear

It is common to have small amounts of ear drainage following the operation. This can go on for several days and even a few weeks. Often the drainage can be bloody. Your surgeons recommend that the bulky bandage is removed on the first post operative day. Cotton and gauze surrounding the ear can be removed. If you have questions about removing anything that is adherent to the ear, you should contact your physician. Do not try to remove anything in the ear canal. Do not get the ear canal wet. You can use a cotton ball coated with Vaseline over your ear canal while you are showering. Do not put your head under water. It is acceptable to clean the wound behind the ear with a water and soap solution after several days. It may be easier to have someone else wash your hair for you and to use a no-tears formula. Most individuals can clean the area behind the ear and apply an antibiotic ointment or antiseptic solution. You may want to keep a cotton ball over the ear canal and change the cotton ball when the drainage soaks through.

Call the Doctor!

1. A fever higher than 100 degrees especially if it lasts for more than 24 hours.
2. Increasing ear drainage. Drainage that gets worse over time or has an odor is a reason to call your physician.
3. Increasing pain.
4. Increasing blood, redness, or swelling around the incision area.
5. Increasing symptoms of dizziness, vertigo or nausea.
6. Any change in symptoms that you are uncertain about.

Conclusions

Most ear surgery is successful. Caution should be exhibited following ear surgery. If you have questions, you should contact the physician's office and discuss any concerns. Someone is always available to answer your questions.