What is Tympanomastoidectomy

Tympanomastoidectomy is a surgical procedure to correct ear problems by repairing a hole (perforation) in the eardrum (tympanic membrane) or by removing excess skin (cholesteatoma) in the middle ear. One or both of these things may be done during the procedure, depending on your condition. Part of the bone behind the ear (mastoid process) is also removed. This procedure is done to treat long-lasting (chronic) ear problems, such as frequent infections, difficulty hearing, or hearing loss.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs.
• Scarring.
• Continued ear problems.
• Another perforation developing in the eardrum.
• Re-growth of cholesteatoma.
• Hearing loss.
• Temporary or permanent loss of taste.
• Facial weakness or numbness.
• Feeling that you or your surroundings are moving when they are not (vertigo).
• Leakage of brain fluid.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You will have a physical exam and hearing tests.
• You may have a blood or urine sample taken.
• Ask your health care provider how your surgical site will be marked or identified.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A small incision will be made behind your ear, near the back of your earlobe.
• An incision will be made in your ear canal.
• If your tympanic membrane is perforated, a small piece of tissue (graft) may be applied so that it covers the perforation. The graft may be taken from tissue under your skin (fascia), close to your ear, or from one of your veins, muscles, or other body tissues.
• If there is cholesteatoma in your ear, it will be removed.
• Part of your mastoid process will be removed. The remaining part of your mastoid process will be opened up and cleaned out during surgery.
• The wall of your ear canal may be reshaped, if necessary.
• The incision in your ear canal will be closed with stitches (sutures).
• The incision behind your ear will be closed with sutures, skin glue, or adhesive tape.
• A bandage (dressing) may be placed over your incision. The dressing may cover your ear completely.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You may continue to receive fluids and medicines through an IV tube.
• You may have some ear pain. Medicines will be available to help you.
• Do not drive for 24 hours if you received a sedative.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.

Tympanomastoidectomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain, popping sounds, and a feeling of fullness in your ear.
• A sense of hearing that is slightly muffled.

Follow these instructions at home:

Ear care

• Avoid direct sunlight on your ears for as long as told by your health care provider. This may help prevent scarring.
  • Wear sunscreen with at least SPF 30, and reapply sunscreen periodically according to instructions on the sunscreen container.
  • Wear hats to protect your ears from the sun.
• Do not lie on your side so that your ear is pressed against the surface you are lying on. This puts pressure on your ear.
• Do not pop your ear, blow your nose, or sneeze through your nose. If you have to sneeze, keep your mouth open and try to sneeze out of your mouth.

Incision care

• Keep your incision and your ear clean and dry.
• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Drink enough fluid to keep your urine clear or pale yellow.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• When your health care provider says that you may take showers, follow instructions from your health care provider about how to keep your ear dry. This may involve covering your ear with a dressing and a plastic covering.

Activity

• Do not lift anything that is heavier than 10 lb (4.5 kg) for 4 weeks, or as long as told by your health care provider.
• Do not fly in airplanes, scuba dive, or significantly change elevation for 6 weeks, or as long as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid making sudden movements with your head and neck, and avoid bending over and standing up quickly. These movements may cause temporary dizziness.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. These may affect healing. If you need help quitting, ask your health care provider.
• If you were told to wear compression stockings, wear them as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You develop new symptoms.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have a fever.

Get help right away if:

• You develop pain or swelling in any part of your feet or legs.
• You have difficulty breathing.
• You have an unusually fast heartbeat.
• You have chest pain.
• You develop numbness or tingling in your face.
• You lose hearing in your affected ear.