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Surgery for Chronic Ear Infections

Chronic middle ear infections that don't go away after three months or more, or become worse and impact quality of life, may require surgery. While there are many possible causes of an ear infection, it is usually bacteria that have become set in the bone. An ear, nose and throat specialist (ENT), who subspecializes in the ear (an otologist / neurotologist) can determine whether or not any of the following surgeries may be necessary.

Myringoplasty

If there is no middle ear infection or disease affecting your ear bone (mastoid bone), this procedure may be recommended. During a myringoplasty, the ear drum is repaired with a tissue graft to improve hearing and to prevent infection from entering the ear. Hearing improvement is usually noticed about 6-8 weeks later when the area has healed.

Bilateral Myringotomy and Tubes (BM-T)

A BM-T involves the insertion of a small tube through the eardrum or inserting small tubes to allow fluid to drain. A small opening is created during the outpatient procedure so the tubes can be properly placed. The tubes usually fall out on their own 6-12 months later.

Tympanoplasty

Performed to eliminate an inner ear infection and reverse hearing loss, a tympanoplasty also repairs the eardrum itself and the parts of the ear that transmit sound. Usually an outpatient procedure, the surgery is usually performed using an incision behind the ear in the crease. The ear drum is repaired with tissue obtained from under the skin called fascia (covering of the muscle). In some situations, cartilage is used to strengthen the eardrum.

Mastoidectomy

Sometimes performed with a tympanoplasty, the purpose of this procedure is to clean out the mastoid, or the bone behind the ear the that connects with the middle ear area (space behind the ear drum). An incision is usually made behind the ear to reach this part of the ear.

Canal Wall Down Mastoidectomy

For patients with cholesteatomas or infections that have destroyed the ear canal, a canal wall down mastoidectomy may be recommended. It is nearly always performed in conjunction with a tympanoplasty depending on the extent of the cholesteatoma. Generally, that area is filled with bone grafts and cartilage to not create a large defect in the ear canal. A bone graft may be necessary to help the ear heal property.

Meatoplasty

When a canal wall down mastoidectomy needs to be performed, the outer opening of the ear canal is sometimes too small. A meatoplasty procedure involves the removal of cartilage to enlarge that opening to allow for easier access to the space that needs to be cleaned.

By the time surgery becomes an option, most patients have been living with ongoing ear pain for six months or more. An ENT doctor who specializes in the ear (otologist / neurotologist) will consider surgery when other treatments are not effective, or if there is hearing loss. .