In some cases of tympanic membrane perforation (hole in the eardrum), the ear becomes chronically diseased and prone to recurrent infection which can result in otorrhea (drainage from the ear). The infections may also cause damage to the structures of the ear such as the ossicles (hearing bones). The infection is usually treated with antibiotic ear drops, but in some cases, surgery may be needed to clear the infection. Most patients will need to keep water out of the ear with ear plugs or a cotton ball with Vaseline to reduce the chance of infection.

 

  
 

Figure 1  Left chronic ear drum perforation
 

 

Another less common result of recurrent ear infections is cholesteatoma which results from abnormal migration of the eardrum skin into the middle ear and area behind the ear called the mastoid. Over time the cholesteatoma typically destroys the bony structures of the ear. Without proper treatment, serious complications such as acute mastoid infection or brain infection may result. The infection is usually treated with antibiotic ear drops, but surgery is usually needed to remove the cholesteatoma permanently. Most patients will need to keep water out of the ear with ear plugs or a cotton ball with Vaseline.

 

  
 

Figure 2 Cholesteatoma source and extension to middle ear behind the ear drum

 

 

 

Tympanoplasty with mastoidectomy

 

Both chronic otitis media and cholesteatoma usually require surgical management in addition to medical treatment. The procedure is an outpatient surgery that takes 2 to 3 hours. It is performed under general anesthesia. The surgery is performed through an incision behind the ear.

 

 

 

Diseased tissue in the ear and mastoid are completely removed. The hole in the eardrum is repaired using the patient’s own tissue, called fascia. If the hearing bones (ossicles) are damaged, they can usually be repaired at the same time. In cases of cholesteatoma, a second surgery may be needed several months later to complete the hearing reconstruction.

 

 
 

Figure 3  Left mastoidectomy with exposure of the cholesteatoma

 

 

 

Figure 4  Left ear with titanium implant to replace hearing bones

 

 

 

Figure 5  Left eardrum with perforation and cholesteatoma

 

 

 

Figure 6  Left eardrum after repair

 

 

 

Antibiotic ear drops are used in the ear after surgery. Regular activities are started the next day. Patients are typically seen 3 weeks after surgery. To ensure proper healing, a hearing test is performed.  Once the healing process is completed, typically 1 to 2 months after surgery, another hearing test is performed.  

 

 

Cholesteatoma is a difficult problem to cure and there is a substantial risk of the disease occurring again. Therefore, after the intitial treatment, follow-up care over many years is very important.

 
Disorders of the Ear