Doc Martin's

126 Quincy Rd.
Cheyenne, WY 82009
(307) 632-9970

Tympanystomy Tubes:

(i.e. ventilation tubes or PE tubes as they are called)

Tympanostomy tubes are indicated for chronic fluid behind the eardrums, usually associated with conductive hearing loss. This is a very common procedure done in young children, usually greater than 1 year of age. For those children who have had chronic fluid or infection that does not clear for 3 months they meet the indications for tympanostomy tubes. Usually these are treated with antibiotic therapy by a pediatrician or family practitioners: after a period of three months with no normal ear exam, referral is made to an EAR ,NOSE and THROAT physician. or Otolaryngology's for evaluation and treatment by placement of tubes.

This is done under general anesthetic usually by mask only. This is intended to give just enough anesthesia so the child lies still and is not under any significant discomfort post-operatively treated by non-steroidal anti-inflammatory agents, given in a dose appropriate for the weight. Children normally recover quite quickly with only minimal drainage for 24-48 hours, usually slightly bloody, If you have persistent drainage lasting more than 48 hours, they need to follow up with their surgeon. The most common problem that occurs after tympanostomy tube placement is that children can still get ear infections and this is exemplified by drainage of mucus, us or blood from the ear canal and requires antibiotic therapy and ear drops.



Tympanoplasty:


Tympanoplasty is a procedure performed for the closure of a hole in the tympanic membrane. Common finding is for conductive hearing loss, in association with a hole in the tympanic membrane and recurrent infections usually associated with water exposure into the ear canal. These can be associated with other problems with regards to the ear, that will be discussed at a later time, primarily to do with cholesteatoma.

The tympanoplasty procedure can be done in several fashions. One way is to do a paper patch myringoplasty,and this is commonly done at the time of removal of tympanostomy tubes, where you remove scar tissue from around the hole where the tympanostomy tube was placed and then a cigarette paper patch is placed over the hole after the scar tissue has been removed. This is usually followed at one week post-operatively and every month until paper patch is no longer over where the hole was and the intact tympanic membrane can be visualized. This works in at least 50% of the cases.

If this does not work a formal tympanoplasty can be performed. A formal tympanoplasty can be done through incisions made in the ear canal, or is done commonly with incisions made in the ear canal and incisions made in the post auricular sulcus, or behind the ear. The incision from behind the ear affords greater visualization during the surgery, and is also used to obtain a tissue graft which is made from the temporal is fascia or the thick lining over the temporal is muscle which is in close approximation with the post auricular incision. This works approximately 90% of patients. The graft is most commonly placed underneath the eardrum with a packing of gel foam material to hold the graft up against the medial wall of the tympanic membrane, in the post-operative period. Additional packing is usually placed in the external auditory canal to hold the ear drum down onto the graft as well.

In the post-operative period there is some bleeding and this is usually dealt with by changing a cotton ball from the area of the opening of the ear canal as needed. Patients are usually seen at one week intervals for 3 visits, to remove all of the gel foam and examine the ear canal after three weeks. Once this is done the patients are usually counseled that the remainder of the gel foam in the middle ear space will dissolve and exit the middle ear space through the Eustachian tube over a period of another month and a half. At two months post operatively the patient should have an audio gram if they have an intact ear drum at that time. If the ear drum is intact at two months the procedure is considered successful. An audio gram is pre-operatively and then again at two months post-operatively to confirm no significant hearing loss has occurred because of the procedure.

This is also to confirm that there is no persistent hearing loss. During the procedure the ear drum is lifted up, the ear bones are examined to make sure they are in contact as they should be. If there is ocular discontinuity, or the bones are not connected as they should be, usually this can be corrected during the surgical procedure for repair of the eardrum depending on where the hole in the ear drum is. If the hole is over where the ear bones make their connections it may be best to do an ocular reconstruction as a second procedure, approximately six months after the initial tympanoplasty. The risk associated with any ear surgery Includes: pain, discomfort, bloody drainage hearing loss which can be conductive or sensorineural. These occur in less than 1/10 of 1% with regards to hearing loss. It is not necessary to have a completely normal appearing middle ear space but it is desirable. It is also desirable that Eustachian tube function is demonstrated when preoperative hearing test is done. This can also be demonstrated in the office by doing a Tybee test.

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