Chronic Ear Disease and Cholesteatoma

Chronic ear disease involves hearing loss, infection in the form of chronic ear drainage (otorrhea), or the development of secondary problems (cholesteatoma) as a result of impaired ear function. Much of this is due to impaired ventilation of the portions of the ear under the eardrum, and is caused by Eustachian tube dysfunction. The Eustachian tube connects the ear to the back of the nose, and is responsible for the “popping” sound and pressure feelings associated with yawning, flying, or blowing one’s nose.

A tympanomastoidectomy is a surgical procedure to address a perforation in the eardrum, and/or to remove a skin cyst made of retracted eardrum (cholesteatoma).   This procedure also involves the removal of a small portion of bone behind/beneath the outer ear.  This is called the mastoid bone, and contains air pockets within it that are part of the ear.  The surgical enlargement of these pockets into one larger cavity is called a mastoidectomy.  When these pockets are chronically infected or filled with cholesteatoma, surgical therapy is the only effective therapy. Chronic ear infection is typically treated with one procedure, while cholesteatoma is treated in two stages (two procedures separated by 6-9 months).

The procedure involves an incision behind the ear and within the ear canal.  Most mastoidectomies keep the bony ear canal intact.  Variations of this procedure include removal of the posterior half of the ear canal, creating a bony cavity that connects to the outer ear canal (canal wall down mastoidectomy).  A modified radical mastoidectomy also includes removal of the hearing bones.  A radical mastoidectomy removes all ear structures between the outer ear canal and bony wall separating the ear form the inner ear/brain. Although surgery may sometimes be lengthy, most children are able to go home the same day, and recover within a few days.

The risks of this procedure include a low risk of bleeding, infection, failure of the eardrum to heal (reperforation), and temporary taste disturbances. There is a low (<1%) risk of injuring hearing, balance (dizziness), or the facial nerve (the nerve that enables facial movement on the same side of the face).  A facial nerve monitor is also used as an added safety measure for protecting the facial nerve.

When properly performed, tympanomastoidectomy can control even the most difficult cases of chronic ear infection and/or cholesteatoma.  This requires experience and a thorough knowledge of ear anatomy, including the variations that may present in many pediatric syndromes. The physicians of PENTA enjoy a high level of experience with this patient population, enhancing the successful treatment of children with chronic otitis and cholesteatoma.

For more information or to make an appointment with one of PENTA’s pediatric otolaryngologists, call 404-255-2033.