Ear Surgery

Ear Surgery

1. Asepsis?

   • Impossible! Peri-operative antibiotics are indicated

2. Aural Haematoma

   • Common
   • Self inflicted due to otitis externa, but occasionally due to autoimmune disease/cushings
   • Fluid filled sweeping on concave surface
     • Whole/portion of pinna
     • Lesion undergoes fibrosis
   • Therapeutic objectives
     • Identify and remove underlying cause
     • Remove Haematoma
     • Maintain normal tissue apposition
     • Prevent recurrence
     • Maintain normal function and appearance of pinna
   • Treatment
     • Needle aspiration
       • Large gauge needle, contents drawn out, corticosteroid injected
       • Aim to reduce inflammation, but may slow healing and prevent normal tissue alignment
       • Highly effective in early cases
     • Incision and sutures
       • Schedule 3 ✅

3. Surgical management of Otitis Externa and Otitis Media

   • Indicated to...
     • Improve drainage and ventilation of external ear canal
     • Remove chronically diseased tissue
     • Gain access to external canal and tympanic membrane
   • Lateral wall resection
     • Lateral wall of vertical canal removed
     • Only performed if no disease to medial wall or horizontal canal
     • Increases drainage and improves ventilation
     • Facilitates placement of topical meds
     • Not curative
     • Complications
       • Poor surgical technique
       • Poor patient selection
       • Failure to control underlying disease
       • Unremitting otitis media
   • Vertical canal ablation
     • Vertical canal completely removed
     • Horizontal canal sutured to skin
     • Only for ears where horizontal canal is normal
     • Doesn't interfere much with hearing
   • Total ear canal ablation (TECA)
     • Indicated in...
       • Chronic proliferative changes in middle ear
       • Complete ear canal stenosis
       • Continuing otitis following previous surgery
       • Unremitting middle ear disease
       • Neoplastic disease
       • Severe trauma to external ear canal
     • Complications
       • Facial nerve injury
       • Wound dehiscence / infection
       • Haemmorhage
       • Vestibular signs
       • Chronic sinus tract and para-aural abcessation
       • Deafness

4. Nursing care post-ear surgery

   • Analgesia
   • Protect ear
     • Collar / head bandage
   • Bath site regularly
   • Sutures stay in place longer than usual
     • Small areas of dehiscence left to heal by second intention