Purpose of operation:
Microscopic surgery such as tympanoplasty or mastoidectomy is used to treat patients with chronic otitis media, otitis media induced eardrum perforation, cholesteatoma, structural defects, ossicles defect or sclerosis, or those needing membrane and ossicles transplantation, those needing to maintain good air conduction or tympanum free from infection and those suffering from conductive hearing loss.

Preoperative preparation:
  1. Get these tests done such as an electrocardiogram, a chest x-ray and blood tests.
  2. Fill out consent forms related to the operation and anesthesia procedure.
  3. Inform the medical staff if you are using any medications or anticoagulants.
  4. Review the care instructions which you will be given by the nursing staff. You should also view the instructional video. If you have any questions, consult the medical staff.
  5. Remove the entire nail polish.
  6. Shampoo your hair the day or night before the operation.
  7. Follow your doctor’s orders to fast either the day before or after midnight during the day of the operation.  
  8. On the operative day, the nursing staff will insert an intravenous line.
  9. On the day of surgery remove your clothes and change to a surgical gown. Remove all accessories, dentures, contact lenses and watch.
  10. Urinate before going to the surgical suite. The nursing staff will confirm all your information shortly before surgery.
 
Post-operative care:
  1. Dietary:
    1. After local anesthesia: first try drinking some water and if you do not experience any discomfort then you can have a regular diet.
    2. After general anesthesia: fast for another 4-6 hours (including no water or food). The nursing staff will inform you when you can eat.
    3. During the surgery the doctor might cut the chorda tympani nerve. Because of this, you might suffer from abnormal taste sensation but this should resolve in about 3-6 months.
  2. Wound care:
    1. While lying in bed after the operation, elevate your head to about 30 degrees.
    2. After the operation the wound will be covered with compression bandages. To avoid abnormal pressure on the wound do not wear glasses. If the bandage is too tight, shifts positions or oozes, inform the medical staff. To prevent the wound from bleeding or swelling, do not remove the bandage yourself.
    3. Use a shower cap while showering to prevent water from entering the ear canal.
    4. During the operation a sponge-like substance with antibiotics will be placed to protect the repaired eardrum. Your hearing may be temporarily affected.
    5. Around 2 weeks after surgery the sponge-like substance will be removed by the doctor. Do not remove it yourself.
    6. If the following conditions occur after surgery, don’t get stressed, please inform the medical staff if:
      • Two days after surgery pain or a throbbing sensation is experienced. The doctor will prescribe medications to help in controlling the pain.
      • The sponge-like substance which is placed to protect the repaired eardrum may cause you to feel or hear a pulse-like throbbing sound, steaming or ringing sound.
    7. After surgery you may suffer from mild dizziness or nausea. When you need to walk do it slowly. It is best to have a family member or other person to help you so that you avoid any fall.
  3. Self-care at home:
    1. Daily life precautions:
      • Minimize chances of getting a cold. Avoid contact with persons suffering with upper respiratory tract infections.
      • Before the sponge-like substance is taken out, please decrease your hair wash frequency. When shampooing, avoid water coming into contact with the sponge-like material.
      • Avoid exposure to the hot sun or hot and humid environments. You need a doctor’s approval before you can go for swimming. 
      • Try to avoid coughing, blowing nose and also try to keep your mouth open while sneezing to reduce pressure on middle ear.
    2. Wound care:
      • Wash your hands.
      • Dressing change material: 1 x 1 inch sterilized gauze pads, sterilized fine cotton swabs, ½ inch wide adhesive tape and antibiotic ointment.
        f4c4a68930479182a1e92d4a556074a0.jpg 
      • Remove the tape and covering gauze to expose the wound.
      • Use a cotton swab to absorb any liquid oozed from the now dark brown sponge-like substance placed at the opening of the ear canal. Gently push the sponge-like substance inside if it protrudes out of the canal.
        fcb62835a98261ac516a085571f760bd.jpg
      • Use a fresh cotton swab and apply a small amount of antibiotic ointment to the stitches in the wound.
        7362b5b4f52df24ebdb9d9d0d213b4ec.jpg
      • Use one of the gauze pads to completely cover the opening of the ear canal. Use another gauze pad to cover the front of the wound if it is near the front of the ear and the back if the wound is near the back of the ear. Tape all the pads in place with adhesive tape.
        944093b6d88d6d1902609ead0ec95c23.jpg
      • When showering or going outdoors during rain, do not let water enter the ear canal. Keep the wound and dressing area clean and dry. 
        5e25157c25ae4f5e2e5c823faff4aafb.jpg
      • After getting discharged, the dressing needs to be changed once a day until the sponge-like substance is removed by the doctor.
      • After getting discharged, follow your doctor’s instructions and go to the outpatient department to have the stitches removed. 
 
References
  1. Hsu, Y. C., Kuo, C. L., & Huang, T. C. (2018). A retrospective comparative study of endoscopic and microscopic tympanoplasty. Journal of Otolaryngology-Head & Neck Surgery, 47(1), 44.
  2. Mukara, K. B., Waiswa, P., Lilford, R., & Tucci, D. L. (2017). Knowledge and care seeking practices for ear infections among parents of under five children in Kigali, Rwanda: A crosssectional study.BMC Ear, Nose, and Throat Disorders, 17 (7), 1-9. doi:10.1186/s12901-017-0040-1
  3. Preyer, S. (2017). Endoscopic ear surgery- a complement to microscopic ear surgery. Hals- Nasen- Ohrenheilkunde, 65(Suppl1), 29-34.
    Quiz
    Please answer the following questions:
    Nursing Instruction Satisfaction
    Please log in to rate
    Location
    Category
    Surgery / Procedure