Otalgia surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Surgery forms the main stay of treatment for major ear pathologies like otitis media (OM), otitis externa, cholesteatoma, mastoiditis, etc., and some non-ear pathologies like TMJ disorders and retropharyngeal abscesses.
Surgery
Primary Otalgia
Otitis Media
Surgical options for otitis media include:
- Tympanocentesis - early intervention
- Myringotomy and Tympanostomy tube insertion to drain the pus from the middle ear.
- Adenoidectomy
Indications for tympanocentesis include:
- Severe otalgia, seriously ill, or appearing toxic.
- Unsatisfactory response to antimicrobial therapy.
- Onset of AOM in a patient receiving antimicrobial therapy.
- Potential suppurative complication.
- OM in a newborn, sick neonate, or patient who is immunologically deficient.
Indications for myringotomy and tympanostomy tube insertion:
- Chronic otitis media with effusion
- Recurrent acute otitis media
- Recurrent otitis media with effusion
- Eustachian tube dysfunction
- Barotrauma
Intratemporal and intracranial complications of otitis media requires surgical consultation. Patients with cleft palate,[1] Down syndrome, or other craniofacial abnormalities, may require early surgical intervention to prevent otitis media.[2]
Otitis Externa
Surgery is now reserved for local debridement, removal of bony sequestrum, or abscess drainage.
Cholesteatoma
Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of cholesteatoma. They are:
- Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. These procedures have the advantage of permanently ridding the patient of cholesteatoma.
- Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. These procedures have the advantage of maintaining a normal appearance, but they have the disadvantage of having a high probability of recurrence.
Mastoiditis
Surgical procedures may be performed (while continuing the medication) if the condition does not quickly improve with antibiotics. The most common procedure is a myringotomy, a small incision in the tympanic membrane (eardrum), or the insertion of a tympanostomy tube into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a mastoidectomy in which a portion of the bone is removed and the infection drained.
Furunculosis of Ear
Incision and drainage may be necessary if the disease is extensive and abscess formation takes place.
Referred Otalgia
Temporomandibular Joint Disorders
Surgical options include:
- Arthrocentesis
- Arthroscopic surgery
- Hemijoint replacement
- Total alloplastic replacement (Arthroplasty)
Retropharyngeal Abscess
Treatment depends upon the size of the abscess as visualized on CT scan or ultrasound of neck. If the abscess is of small size, needle aspiration can be done to completely evacuate the pus. For extensive abscesses, which spread deep into the fascial planes of the neck, open surgery proves to be the best option to prevent further spread and ensure complete removal of the abscess.
Peritonsillar Abscess
Two invasive procedures have been recommended for treating a peritonsillar abscess. They are:
- Needle aspiration - can be used both as diagnostic and a therapeutic procedure.
- Incision and drainage - Intraoral incision and drainage is performed by incising the mucosa overlying the abscess, usually located in the supratonsillar fold.
Dental Caries
Treatment options include removal of the decayed part of a tooth and performing dental restoration, root canal therapy, and dental extraction.
References
- ↑ Klockars T, Rautio J (2012). "Early placement of ventilation tubes in cleft lip and palate patients: Does palatal closure affect tube occlusion and short-term outcome?". Int J Pediatr Otorhinolaryngol. doi:10.1016/j.ijporl.2012.06.028. PMID 22796197. Unknown parameter
|month=ignored (help) - ↑ Hartzell LD, Dornhoffer JL (2010). "Timing of tympanoplasty in children with chronic otitis media with effusion". Curr Opin Otolaryngol Head Neck Surg. 18 (6): 550–3. doi:10.1097/MOO.0b013e32833febc4. PMID 21045692. Unknown parameter
|month=ignored (help)