Care of Patient with Microscopic Ear Surgery

【Major points】

Please prevent the wound from water to keep it dry and clean after surgery.
The ear canal packing will usually remain in place for 2-4 weeks. Do not remove it by yourself.
Avoid catching a cold and avoid hot or stuffy environments. Do not swim until your doctor says it is safe to do so.

What is the microscopic ear surgery?

Microscopic ear surgery uses an endoscope (a medical instrument inserted through the body's natural passages or openings to examine the inside of the body) or a microscope (an instrument that magnifies tiny objects so they can be seen by the naked eye) to enlarge the surgical field and perform surgery inside the ear.

Why Is this surgery needed?

Patients with chronic otitis media, a perforated eardrum, cholesteatoma(abnormal growth of skin cells in the middle ear), or damaged or hardened ossicles may develop ear discharge(continuous accumulation or drainage of abnormal fluid from the ear canal),hearing loss, and ear pain. Reconstruction of the eardrum and ossicles requires this microscopic surgery.
Ear surgeries include tympanoplasty(a general term for surgery to treat chronic otitis media) and mastoidectomy(surgery to remove cholesteatoma from the middle ear).
Microscopic surgery has a smaller incision, usually causes less pain, and can improve hearing loss.

What should I prepare before surgery?

Preoperative examinations include an electrocardiogram (ECG), a chest X-ray, and blood tests.
Before surgery, your doctor will explain the purpose and procedure of the operation and ask you to sign the surgical consent form and anesthesia consent form.
If you are taking medications for chronic diseases or anticoagulants (medicines that prolong blood clotting time and reduce the formation of blood clots), please inform your doctor.
Please wash your hair on the night before surgery.
Do not eat or drink anything, including food and water, after 12:00 midnight before surgery. Take your medications only as instructed by your doctor.
Please empty your bladder before going to the operating room.

What should I know after surgery?

Diet:
1. After surgery under general anesthesia, you may begin eating 4–6 hours after the operation. After surgery under local anesthesia, drink some water first. If you do not cough or feel uncomfortable, you may begin eating.
2. If necessary during surgery, the nerve to the ossicles may be cut through the middle ear. After surgery, you may notice changes in your sense of taste. This usually improves gradually within 3–6 months.
Wound care:
1. While resting in bed after surgery, keep the head of the bed elevated. Do not wear glasses to avoid putting pressure on the ear wound.
2. After surgery, your head and ear wound will be covered with gauze or wrapped with an elastic bandage. The doctor will remove it after 1–2 days. Do not loosen or remove it by yourself, as this may cause bleeding or swelling. If the bandage feels too tight, becomes loose, or shows signs of bleeding, please inform the healthcare staff immediately.
3. It is recommended to wear a shower cap while bathing to prevent water from flowing into the ear canal.
4. The ear canal packing placed during surgery is a mixture of sponge-like material and antibiotics to protect the newly repaired eardrum. Therefore, your hearing may be temporarily reduced.
5. The ear canal packing usually remains in place for 2–4 weeks. Do not remove it by yourself. Your doctor will remove it during your follow-up visit.
Postoperative Care
1. After surgery, you may occasionally feel weak, dizzy (a spinning or swaying sensation), or experience nausea and vomiting.
2. If you need to get out of bed to use the bathroom, move slowly. It is best to have a family member assist you to prevent falls.
3. Nausea and vomiting are common side effects of anesthesia. While you are unable to eat, intravenous fluids will be given to help your body metabolize the anesthetic. You may take anti-nausea medication as prescribed by your doctor or listen to music to relax and relieve discomfort.
4. After surgery, you may experience pain or brief sharp pain at the surgical wound. You may take pain medication as prescribed by your doctor.
5. After surgery, you may notice a pulsating sensation in the ear, the sound of flowing water, or worsening tinnitus
6. If you lose your hearing after surgery, please inform the healthcare staff immediately.

What should I know after returning home?

Daily life
1. Avoid catching a cold and avoid contact with people who have upper respiratory tract infections, such as the common cold, influenza, nasopharyngitis, tonsillitis, or laryngitis.
2. Wash your hair as infrequently as possible until the ear canal packing is removed. If you need to wash your hair, avoid getting water on the ear wound or the ear canal packing.
3. Avoid exposure to direct sunlight and hot or stuffy environments whenever possible.
4. You may swim only after your doctor approves.
5. Avoid forceful coughing or blowing your nose. Keep your mouth open when sneezing to help equalize the pressure in the middle ear.
Wound dressing:
1. Wash your hands and prepare the following supplies: 1 × 1-inch sterile gauze, sterile cotton swabs, 0.5-inch paper tape, and antibiotic ointment as prescribed by your doctor (Figure 1).
  Figure 1 Dressing Change Supplies
2. Remove the old gauze covering the operated ear to expose the wound. If you are changing the dressing by yourself, you may do it in front of a mirror. Use a clean cotton swab to absorb any fluid on the dark brown packing at the opening of the ear canal. If the packing protrudes outward, gently press it with the cotton swab and push it back into the ear canal (Figure 2).
  
  Figure 2 Wound Cleaning
3. Use a cotton swab to apply a small amount of antibiotic ointment to the ear canal packing and the wound stitches (Figure 3).
  
  Figure 3 Applying Antibiotic Ointment
4. Cover the opening of the ear canal completely with one 1 × 1-inch piece of sterile gauze. Then place another piece of sterile gauze over the surgical wound and secure it with paper tape (Figure 4).
  
  Figure 4 Securing the Gauze with Paper Tape
5. While bathing, keep the wound and gauze clean and dry. Do not allow water to enter the ear canal or wet the ear canal packing.
6. After discharge, change the dressing once a day until the ear canal packing is removed.
7. Please return to the Otolaryngology Clinic for follow-up as instructed by your doctor.