Ear Surgery

Ear Surgery, Middle Ear and Eardrum Repair

Ear surgery is a treatment method used for eardrum perforations and inflammation in the middle ear. The aim of ear surgery is to clean the infection in the middle ear, repair the damage caused by it, and then renew the eardrum.

Perforations in the eardrum can lead to varying degrees of hearing loss. If these perforations cause discharge and hearing is not severely affected, they can be monitored without intervention.

However, damage to the eardrum not only causes hearing loss but also creates a constant susceptibility to infections. The ear must be protected from water, avoiding contact during swimming or bathing. This significantly reduces quality of life.

When Should Ear Surgery Be Performed?

Thanks to the convenience and practicality of modern medical techniques, ear surgery is commonly applied for eardrum repair and middle ear diseases.

In more serious middle ear conditions, infection and continuous discharge are usually present. The infection may spread to the bone behind the ear called the “mastoid,” and manifest with perforations in the upper and back parts of the eardrum or retractions in the eardrum itself, which are considered more dangerous areas.

Such conditions not only lead to persistent serious infections but also worsen hearing loss. The most severe form of infection is called cholesteatoma, which continuously expands and erodes surrounding bones.

This condition, classified as a complication, may lead to meningitis, abscesses under the brain membrane, brain abscesses, permanent and profound hearing loss, severe dizziness, and facial paralysis. In such cases, surgery is considered and often inevitable.

Ear surgeries, depending on the severity of the condition, may involve only eardrum repair (myringoplasty), eardrum and middle ear repair (tympanoplasty), eardrum, middle ear, and ossicular chain repair (tympanoplasty with ossicular chain reconstruction), and in addition, surgery for mastoid bone infections (tympanomastoidectomy, modified radical or radical mastoidectomy).

How Is Ear Surgery Performed?

In eardrum repair, the patient’s own tissue is used. The fascia around the muscles is typically used. If a stronger and non-collapsing membrane is required, cartilage and perichondrium are used. In ossicular repair, a special paste-like adhesive, cartilage, the patient’s own ossicles, or prosthetics made of special materials may be preferred.

Eardrum repairs have a success rate of 80-85%. Hearing improvement varies depending on the extent of infection, with a success rate of 50-70%. Infection and cholesteatoma may recur in 10-20% of cases.

Ear surgery requires high attention and significant experience due to its proximity to critical and delicate tissues. However, surprisingly, for the patient, it is a relatively easy procedure with minimal pain, allowing return to work within 4 to 7 days.

It can be performed under local or general anesthesia. Depending on the type of surgery, it lasts between 1 and 3 hours. In procedures through the ear canal, no incision is made; in other cases, a 5 cm incision behind the ear may be required, which leaves no noticeable scar and does not cause severe pain.

This surgery does not typically involve major bleeding. In advanced infections requiring mastoid cleaning or in cholesteatoma cases, there is a risk of damaging the brain membrane, permanent hearing loss, and facial paralysis. However, in the hands of experienced surgeons, these risks are very low.

In patients who undergo ear surgery, such problems can be resolved with high success rates. Infections that may cause serious health issues in the future are eliminated. As a result, patients experience ears that no longer discharge or cause problems, thus significantly improving quality of life.

Cholesteatoma

Cholesteatoma is a condition where the skin layer covering the outer part of the ear canal and eardrum advances into the middle ear, where it does not belong. Cholesteatomas generally occur due to chronic middle ear infections.

In some cases, congenital cholesteatoma may occur due to abnormal development of skin cells. In cholesteatoma, a cyst composed of skin cells forms in the middle ear through a perforation in the eardrum.

The cholesteatoma cyst present in the middle ear gradually enlarges over time and begins to damage the surrounding bones and the structures they protect.

What Are the Symptoms of Cholesteatoma?

The most common symptom of cholesteatoma is a foul-smelling discharge from the ear. As the cholesteatoma cyst grows, it increases the sensation of fullness in the ear, pressure, and pain.

As a result, the patient experiences hearing loss. Cholesteatoma may reach the inner ear through bone erosion. In this case, irreversible sensorineural hearing loss may occur. In advanced stages, facial paralysis may also develop.

Bone erosion that reaches from the upper ear to the brain or from the back of the ear to the cerebellum can lead to serious health problems, including meningitis and brain abscess.

How Is Cholesteatoma Diagnosed?

Early diagnosis of cholesteatoma makes treatment easier and more successful. Therefore, patients should consult a specialist upon noticing any symptoms. Cholesteatoma can be diagnosed easily with a specialist examination.

A CT scan of the ear bones, MRI, and hearing tests provide a clearer picture of the condition.

How Is Cholesteatoma Treated?

The treatment for cholesteatoma is surgical. The main goal of cholesteatoma surgery is to completely remove the cyst and treat the chronic infection in the middle ear. Cholesteatoma surgery should only be performed by specialists with proven expertise.

The primary goal of treatment is to fully clean the infection and cholesteatoma; the secondary goal is to preserve and restore hearing function. If there is advanced damage in the auditory structures, multiple operations may be needed. If left untreated, cholesteatoma may cause facial paralysis.

In such cases, emergency surgery is needed to relieve pressure on the facial nerve and ensure its recovery.

What Causes Cholesteatoma?

Cholesteatoma can result from various factors. Common causes include:

• Chronic ear infections,
• Sinus infections,
• Frequent colds,
• Allergies

What Are the Symptoms of Cholesteatoma?

There are numerous symptoms of cholesteatoma. Typically, the symptoms follow a distinct pattern. As the cyst inside the ear grows, symptoms become more severe. In the early stages, foul-smelling discharge is noticed. As the cyst grows, a sensation of pressure occurs in the ear.

Additionally, pain may be felt inside or behind the ear. As the cyst grows further, the pressure increases, leading to hearing loss. Due to the seriousness of these symptoms, treatment is very important. Cholesteatoma surgery is performed under general anesthesia.

During the operation, the cyst is removed, and damaged structures in the middle and inner ear are repaired. Postoperative monitoring of the patient is crucial. Even after removal, cholesteatoma may recur, making follow-up essential.

If the cyst has damaged the bony structures of the ear, a second or even third surgery may be necessary. After successful surgery, the patient’s quality of life significantly improves. The recovery period and return to daily life are generally short.