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Monday, July 28, 2008

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The type of operation planned will depend on many factors which will be discussed with the patient in the clinic. Often after a 3rd or 4th Combined approach tympanoplasty where the disease is difficult to remove a decision may be made to convert the ear to a modified radical mastoidectomy.   


The Operation
The CAT and MRM are similar so far as the patients course through the operative period is concerned. All patients are seen 1 week before the operation to ensure all the investigations (a hearing test and CT scan of the ear) are in place and there are no further questions that need addressing. The patient is admitted on the day of the operation and seen by the surgeon and anaesthetist.
The operation takes 2/3 hours under a general anaesthetic. An incision is made behind the ear. The mastoid bone is drilled to allow access to the disease and the cholesteatoma is removed. If the ear is disease free in a second look CAT the ear bones of hearing will be reconstructed. A dressing pack is inserted into the ear, the wound sutured and a head bandage applied.

The risks of the operation are very similar to the risk of the cholesteatoma disease itself. These include worse hearing, total hearing loss, dizziness, weakness of the face due to facial nerve damage, numbness of the external ear and change in taste sensation.

Postoperative recovery
The patient stays in hospital overnight and after removal of the head bandage and checking of the wound, allowed home. Sutures are removed from behind the ear at 1 week and the dressing removed from the ear canal in the clinic at 2/3 weeks.
2 weeks off  work or school is required and flying is not appropriate for 2 months.