Drainage of the tympanic cavity
Drainage of the tympanic cavity is performed in the case of otitis media with effusion unresponsive to conservative treatment (pharmacological treatment and procedures involving blowing the auditory tube). Surgical treatment consists in removal of the fluid in the tympanic cavity through small (1.5-2 mm) incision made on the tympanic membrane and placing there ventilation tube. Its shape resembles microscopic spool for threads with wider flanges on both sides and narrow central part in which a channel is made to ensure the airflow from the external auditory tube to the tympanic cavity. Long-lasting middle ear ventilation is necessary to restore correct conditions of the mucosa in tympanic cavity and to reduce the amount of fluid secreted.
Ventilation tube is placed through the external auditory tube with use of surgical microscope. In children, this precise procedure required short-term general anaesthesia (intravenous), while in adults it can be performed under local anaesthesia. Typical ventilation tubes usually fall out spontaneously after 6-9 months and are found in the external auditory tube during a follow-up visit at laryngologist. In the case of tubes designed for tympanic cavity ventilation lasting for several years, their removal should be performed by a specialist.
Due to the small size and weight, ventilation tubes are not felt by the patients. They do not limit their activities: it is allowed to wash hair, swim and practice sport. Only diving is disallowed.
Reconstruction of eardrum (myringoplasty)
The eardrum is usually damaged due to inflammation of the middle ear or injury (pressure injury as a result of strike to the ear, explosion, sudden change of pressure during diving; direct injury of the eardrum as a result of cleaning ears with objects unfit to this activity). Defect (perforation) of the eardrum results in hearing deterioration and may cause tinnitus, vertigo and recurrent suppurative leaks from the ear.
Due to high regeneration ability of the eardrum, new perforations of limited size usually heal spontaneously and treatment is limited to observation and protection of the ear against water. Persistent perforations require surgical treatment.
Surgical reconstruction of the eardrum (myringoplasty) is performed under a surgical microscope and the eardrum is accessed through external auditory tube or through incision made behind the ear lobe. Due to the microsurgical nature of the procedure and patient’s comfort, surgery is usually conducted under general anaesthesia and only in extraordinary situations under local anaesthesia. The continuity of eardrum is restored with tissues collected from the patient: temporal fascia, perichondrium and/or cartilage from the ear lobe. For the first 7 days after the procedure, auditory tube is covered by a dressing and the effects on hearing cannot be assessed. Preliminary assessment can be made after the dressing is removed but final effect on hearing can be determined after healing process is completed, i.e. after approx. 4 weeks after the surgery.
Plastic surgery of protruding ear lobes
Protruding ears are one of the most common congenital defects which may result in problems with relationships of children with their peers. Incorrect location of the ear lobe is associated with impaired development of the external ear cartilage.
Correction of protruding ears consists in surgical modelling of the cartilage to obtain anatomical appearance of the ear and to stabilise it in correct location in relation to the skull. To obtain permanent and satisfactory results, surgery must be performed after the cartilage growth process is completed, i.e. after a child’s sixth birthday.
Surgery may be conducted both under local and general anaesthesia. Incision in made on the back surface of the ear lobe. Therefore, postoperative scars are not visible. After the surgery, it is necessary to wear elastic band on the head which ensures correct position of the ear lobes. For the first 2 weeks, a band should be permanently worn but for the subsequent 2 weeks it should be worn during the night.