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Chronic Middle Ear and Mastoid Diseases

Chronic otitis media (infection of the middle ear) is the cause of your ear problem. The symptoms depend on the severity of the disease, the involvement of the mastoid bone and whether there is a hole in the ear drum (perforation). These symptoms may include ear discharge (drainage), hearing loss, dizziness, tinnitus (noise in the head) and, rarely, weakness of the face.

Hearing loss and middle ear disease

The external and middle ear conduct the sound and the inner ear is the receiver. A problem involving the external or middle ear causes a conductive hearing loss. An inner ear or ear nerve problem causes a sensorineural or nerve loss.

Any diseases affecting the ear drum or the three small bones of hearing may cause a conductive hearing loss. The hearing loss may be due to a hole in the ear drum (perforation), or destruction of one or more of the three small bones of hearing (ossicles).

An acute infection may develop in the middle ear with resultant rupture and perforation of the ear drum. The perforation may fail to heal and lead to intermittent or constant ear drainage and hearing loss.

Non-surgical treatment

Medical or non-surgical treatment may be useful when a perforation has been present for a short time with associated ear discharge. The treatment involves ear drops, antibiotics, and careful cleaning of the ear by an ear surgeon.

Water should be prevented from entering the ear in all cases of perforation of the ear drum. This is avoided by placing an ear plug such as "Blue Tak" or cotton wool mixed with Vaseline in the outer ear canal. Swimming is possible with an earplug and bathing cap, but diving must be avoided.

Surgery

Modern surgical techniques of the ear make possible the reconstruction of the ear drum with resulting control of infection and prevention of serious complications. The new techniques of reconstruction can also lead to a marked improvement in hearing.

Tympanoplasty

A tympanoplasty is an operation that eliminates infection from the middle ear lining and closes the perforation of the eardrum. It may also include the repair of the small bones of hearing if damage has occurred.

The operation may be performed under local anaesthetic painlessly with the combination of intravenous sedation (the patient is drowsy). A small incision is made near the top of the ear canal and a graft is taken to repair the eardrum. The operation may also be carried out under general anaesthesia (the patient is asleep). An incision behind the ear may be performed if special techniques are required to enlarge the ear canal in addition to the tympanoplasty.

The procedure often requires two operations to complete reconstruction of the ear drum and sound transmitting mechanisms. The small bones of hearing may be replaced by a synthetic prosthesis, your own cartilage, or they may be repositioned. The patient is hospitalised for one or two nights and may return to work in a week to ten days. Antibiotic packing is placed in the ear canal and this is removed at the first post-operative visit. Healing will not be complete for at least six weeks and water should be prevented from entering the ear canal during that time.

Tympanoplasty and mastoidectomy

In some cases the infection of the middle ear and mastoid becomes chronic and persistent drainage occurs despite all measures. Chronic infection may lead to permanent hearing loss, dizziness, or even weakness of the face and brain infection. These situations usually require the procedure of tympanoplasty with mastoidectomy. When destruction by chronic infection is widespread in the mastoid bone, the surgical elimination of this can be difficult and requires meticulous surgery.

The tympanoplasty and mastoidectomy procedure removes the diseased lining of the mastoid and middle ear and the eardrum is reconstructed. This requires a general anaesthetic with an incision behind the ear with one or two nights in hospital. The patient can usually return to work in one or two weeks.