Ear Tube Removal and Repair of Eardrum

Surgery March 31st to remove the ear tube and do a paper patch on my ear drum.  Dr. Danko Cerenko did the surgery at Southern Regional in Atlanta.  Very short procedure; only under 30 minutes.  Went home that day.  No pain.  Just a lot of packing in the ear which has to stay in for two weeks.  Hopefully my eardrum will heal properly and that will be that.

CSF Leaks Article

http://www.utmb.edu/otoref/grnds/CSF-leaks-050112/CSF-leaks-050112.htm

Excerpts from another very good article.

"Cerebrospinal fluid (CSF) leaks are composed of CSF rhinorrhea or otorrhea, which implies an abnormal communication between the subarachnoid space and the nasal cavity or tympanomastoid space.  CSF leaks may present in a number of ways, including middle ear effusion, hearing loss, or unilateral rhinorrhea secondary to Eustachian tube drainage.  Therefore, the otolaryngologist must keep a high clinical suspicion.  The diagnosis must be either confirmed or excluded as the risk of meningitis is high, with reported rates varying between 2-88%.  The clinician must be aware of the diagnostic and treatment options available in order to best manage such patients."

"With transverse fractures, the tympanic membrane is typically intact and the fluid may build within the middle ear and mastoid and eventually drain thought the eustachian tube producing CSF rhinorrhea."

"Surgical repair is recommended for those cases that do not resolve in order to prevent the morbidity and mortality associated with meningitis.  Tegmen defects may be multiple rather than single, and identifying only one defect may not be sufficient for achieving definitive repair.  Because surgical repair by way of a mastoidectomy approach alone can be inadequate if there are multiple tegmen defects, a middle fossa approach alone or in combination with a transmastoid approach should be considered in most cases."

"The success rate is significantly higher for those patients who undergo primary closure with a multi-layer technique (using bone wax plus 2 additional materials, such as Oxycel cotton, muscle, fascia, or abdominal fat) versus those patients who underwent primary closure with a single-layer technique.  The surgeon should also be prepared to deal with an encephalocele encountered incidentally during surgery.  This herniated, pedunculated tissue is functionless and can be amputated."

"The successful management of a patient with a history suggestive of a CSF leak involves ensuring that it is a true leak by testing the fluid for beta-2-transferrin.  Imaging studies should be performed in order to anatomically localize the site.  Surgery, if necessary, should minimize morbidity while maximizing the chances of a successful outcome.  This may be achieved by meticulous preoperative assessment and meticulous intraoperative techniques.  Success rates of over 90% can be expected with proper patient and surgical selection."

 

Neurotologist Apt Update 3-2-11

I had an audiogram (hearing test) and saw my neurotologist today.  Hearing is about the same as last time.  He won't be able to know my real hearing level until after he removes the tube. Will schedule surgery for that in April.  I will have to go under general anesthesia but it should be quick.  He will remove the tube and do a patch immediately to promote healing of the eardrum. 

In the meantime, I have to continue to avoid getting water in my ear.  I told him that is going to be a BIG PROBLEM when I go to St. Martin in 3 weeks!!!  He agreed that I could use a silicone ear plug and he sold me an Ear Band-It which I will have to use to get in the water.  It will just look like I have on ear warmers when I am swimming!!  I am sure it will be cute (NOT!)  He also prescribed me antibiotic drops to put in my ear should any water accidentally get in.

As for my residual palsy, he said it was definitely related to the surgery. My right eye still won't tear and he told me to continue to use drops hourly and a gel at night.  There is no way to really tell if that will come back, but if it does it could be months.

Lastly, he looked into my nose and said the swollen turbinates and bloody discharge are probably due to some minor irritation or injury from the surgery (tubes in nose when asleep?)  He did not think it was anything serious.  He recommended sinus rinses, antibiotic ointment, and AYR gel (saline gel) in my nostrils.

So, I'll schedule the surgery when I come back from my birthday trip and after that, we'll see how my hearing shakes out and if there is anything that can be done to improve it.  But if that's all I have to deal with after all this, I consider myself one lucky girl.

Very informative article on CSF leaks

Cerebrospinal Fluid (CSF) Leaks

This is basically my story...

Spontaneous leaks into the middle ear are usually diagnosed by high-resolution CT scans. This may reveal discrete tegmen defects (mine was 11mm), multiple pinhole fistulae (I had 4), or a combination of these findings. About 6% of the population has some degree of bony defect. Most patients have an ipsilateral conductive or mixed hearing loss, the conductive component caused by CSF in the middle ear. These can be repaired via a middle fossa craniotomy (Leonetti et al, 2005). Surgical repair is used in patients with leaks in the skull.

While CSF leak is generally accompanied by an orthostatic (upright only) headache, this association is not universal and in fact, hearing loss may be more common than headache (this was true for me...I had hearing loss but no headache.)(Oncel et al, 1992).

In theory, a ventilation tube should not be put into an ear with a CSF leak, as this might provide a route for infection to enter the brain. Practically however, the middle ear is not sterile --and it communicates with the nose through the eustachian tube. We also do not know of any study in which infection rates with and without tube were compared -- thus it seems to us that this idea is not only purely theoretical, somewhat illogical, and also unverifiable. My doctors recommended a tube in my ear.

Only 20 cases of leaks due to middle ear infection had been reported as of 2007 (Manjunath, 2007).