At a glance
- Purpose
- To close the eardrum, remove cholesteatoma and rebuild the hearing bones.
- Techniques
- Myringoplasty, tympanoplasty, mastoidectomy and endoscopic ear surgery.
- Anaesthesia
- Usually general.
- Hospital stay
- Day surgery or one night.
- Back to normal
- Within 1 to 2 weeks; keep the ear dry until advised.
Perforated eardrum
The eardrum can be perforated by infections, blows, sudden pressure changes or after grommets. A perforation that does not heal causes hearing loss and leaves the middle ear exposed: water and infection get in easily and the ear often discharges.
- Myringoplasty: the perforation is closed with a graft of the patient’s own tissue, usually taken from near the ear.
- Tympanoplasty: as well as closing the eardrum, the hearing bones are checked and rebuilt if necessary.
Cholesteatoma
Cholesteatoma is a build-up of skin inside the middle ear that grows slowly and erodes the bone around it. It can damage the hearing bones, the inner ear and the facial nerve, and cause serious infections. So although it is benign, the treatment is surgical.
Common symptoms: persistent, foul-smelling ear discharge, hearing loss, a blocked feeling in the ear and, at later stages, dizziness or facial weakness.
Diagnosis
- Video otomicroscopy and oto-endoscopy to see the eardrum in detail.
- Full hearing test.
- Ear CT scan to see the extent of the cholesteatoma and the anatomy.
- Diffusion-weighted MRI, in some cases, during follow-up.
The operation
Surgery combines microsurgery under the microscope with endoscopic ear surgery. Ear endoscopes show corners the microscope cannot reach and, in some cases, allow surgery through the ear canal with no incision behind the ear.
For cholesteatoma, all the disease is removed (sometimes with a mastoidectomy, opening the bone behind the ear), the eardrum is rebuilt and, where possible, so is the chain of hearing bones, using the patient’s own bone or a prosthesis.
Recovery
- First few days: a blocked ear and mild discomfort. If there is an incision behind the ear, stitches are removed at the clinic.
- Care: keep the ear dry, do not blow your nose hard and avoid flying until advised.
- Check-ups: material in the ear canal is removed and healing is monitored. Final hearing is assessed after a few weeks.
- Cholesteatoma: needs follow-up for several years to detect any recurrence early. In some cases a diffusion-weighted MRI is done as a check.
Risks
Persistent or recurrent perforation or cholesteatoma, hearing loss, dizziness, altered taste and, exceptionally, facial nerve weakness. We will explain the risks in your case before surgery.
Frequently asked questions
Is cholesteatoma a cancer?
No. It is benign, but it grows and erodes the bone around it: the hearing bones, the inner ear or the facial nerve canal. That is why surgery is recommended once it is diagnosed.
Will a perforated eardrum heal by itself?
Small, recent perforations, for example after a blow or an infection, often heal on their own. Those that last more than a few months or discharge often usually need surgery.
Will my hearing improve?
With a simple perforation, closing the eardrum usually improves hearing. With cholesteatoma the main goal is to remove the disease safely; hearing is preserved or rebuilt where possible, sometimes in a second operation.
Will I be able to swim?
Once fully healed, in most cases yes. We will advise you at your check-ups.
Will I need a second operation?
For some cholesteatomas a second look is planned a few months later to check that no disease remains and, if needed, to rebuild hearing. Special MRI sequences now help to avoid unnecessary second operations.
You may also be interested in
- Otosclerosis surgery (stapedotomy)
- Ventilation tubes (grommets)
- Second opinion before ENT surgery
- International patients
Before surgery you receive the informed consent document of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC), which explains the technique, its alternatives and its risks.
Guidance written by the team of Dr. Carlos Magriñá, an ENT surgeon with more than 35 years of experience in Barcelona. Every case needs an individual medical assessment.