Chirurgia ucha/Surgery of the ears

Only in case of remission or severe stenosis, a surgical therapy may start. However, it should not be delayed after head tilt, because any advancement of the infection into the inner ear is associated with a guarded prognosis.

The gold standard for chronic otitis externa is a total ear canal ablation together with a lateral bulla osteotomy (TECA LBO). It has been shown, that in chronic stages of the disease, the tympanic membrane cannot stop the advancement and the bulla is always affected. A TECA LBO results in a very good cosmetic outcome, because the pinna is left intact. A little bit caution is given to the facial nerve, which runs directly ventral to the anular cartilage and which may be embedded in inflamed tissue. After detaching the well prepared auditory tube, the entrance into the bulla is opened with rongeurs. The bulla is then curetted with caution to avoid damage to the nerves of the autonomic nerve system. A drainage is only set in very contaminated areas.

Complications followed by a TECA LBO are:

• temporary facial nerve palsy,
• Horner’s syndrome (enophthalmus, ptosis, miosis, protrusion of the third eyelid),
• and late fistulation of not removed cutaneous tissue.

The hearing is reduced after TECA LBO. However this was already the case before the intervention. Sonic waves [...]

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