What is the "Mastoid Bone"
The mastoid bone is located behind the ear (felt as a hard bump behind the ear). Inside it looks like a honeycomb, with the spaces filled with air. These air cells are connected to the middle ear through an air filled cavity called the mastoid antrum. Although the mastoid bone serves as a reserve air supply to allow normal movement of the eardrum, its connection to the middle ear may also result in the spread of middle ear infections to the mastoid bone (mastoiditis).

What is a mastoidectomy?
A mastoidectomy is a surgical procedure designed to eliminate infection or growth in the bone behind the ear (mastoid bone). Its purpose is to create a "safe" ear and prevent further damage to the hearing apparatus.

What are the indications for a mastoidectomy?
A mastoidectomy is indicated for mastoiditis that does not respond to antibiotics. A mastoidectomy is also helpful in preventing further complications of mastoiditis.

These include meningitis (infection in the fluid surrounding the brain), brain abscess (pocket of infection in the brain) or blood clots in the veins of the brain.

Mastoidectomy is often indicated for other diseases that spread to the mastoid bone, such as, Cholesteatoma. This procedure allows complete removal of these benign yet destructive growths. Occasionally, a mastoidectomy may be used to help find and repair an injured facial nerve.

What is done in preparation for a mastoidectomy?
A complete physical examination of the ear area including the appearance of the outer ear, eardrum and middle ear is performed. Facial nerve function is also evaluated. Hearing tests and pictures (mastoid x-ray or CT scan) are also obtained prior to surgery.

What is involved with a mastoidectomy?
A mastoidectomy is performed with the patient fully asleep (under general anaesthesia). A surgical incision is made behind the ear. The mastoid bone is then exposed and opened with a surgical drill. The infection or growth is then removed. The incision is closed with stitches under the skin. A drainage tube may also be placed.

Depending on the amount of infection or cholesteatoma present, various degrees of mastoidectomies can be performed.

Simple Mastoidectomy: The surgeon opens the bone and removes infection. A tube may be placed in the eardrum to drain any pus or secretions present in the middle ear. Antibiotics are then given intravenously (through a vein) or by mouth.

Radical Mastoidectomy: It is used for removing most of the bone and is indicated for extensive spread of a cholesteatoma. The eardrum and middle ear structures may be completely removed. Usually the stapes (the "stirrup" shaped bone) is spared if possible to help preserve some hearing.

Modified Radical Mastoidectomy: This is performed if some middle ear bones are left in place and the eardrum is rebuilt (tympanoplasty). Both, a modified radical and a radical mastoidectomy, usually result in less than normal hearing.

A hospital stay is usually required overnight for children.

Dos and Don'ts: After you leave hospital to look after your ear

• Keep your ear and the wound dry. Take care when showering and washing your hair, to avoid infection.


• Place a piece of cotton wool covered in Vaseline in the ear to prevent water from getting into the ear. This also means you cannot go swimming until you have seen your doctor in the out-patient clinic.


• Change the cotton wool in your ear daily. Always wash your hands before and after doing so. Take care not to remove the ear dressing with the pack. If it sticks to the cotton wool then cut it close to the cotton wool, but do not pull the dressing out.


• Itchiness & redness is rare and it may mean you are allergic to the dressing. If you experience it, contact the ward on the number on the next page.

Things to avoid:

• Blow your nose gently from side to side. If you need to sneeze, try to do so with your mouth open.
• Try to avoid contact with family and friends who have colds for a month after your operation. There is a risk that a cold could lead to an ear infection which would destroy the graft while it is healing. If you catch a cold, you should consult your doctor.
• Avoid changes in atmospheric pressure, which causes your ear to 'pop' as this can damage the graft.
• Avoid strenuous work, sporting activities and straining until you have been seen in out-patient department.

General Risks of having the procedure:
These have been mentioned in the “Anesthesia Consent Form”. Please discuss this with your Anesthetist before signing the Anesthesia Consent Form.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However, it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

Bleeding or infection in the ear or in the wound:

• Rarely, an infection may spread to adjacent structures including the brain causing meningitis or a brain abscess
• Facial nerve palsy: Injury to the nerve controlling the muscles of the face may result in paralysis of the face muscles. This may be temporary or may rarely be permanent
• Persistence or recurrence of the cholesteatoma might occur requiring further surgery
• Ringing in the ear (tinnitus), dizziness or an altered sensation of taste may occur temporarily or permanently
• Partial loss of hearing or total loss of hearing may rarely occur and may be permanent
• Failure to improve hearing: An improvement in hearing may not be apparent despite the surgery being successful in eliminating the disease
• Discharging ear: Persistent pain and discharge may occur requiring further surgery

What is "Microlaryngoscopy"?
Laryngoscopy is a procedure that allows the physician to look at the larynx (voice box) using a laryngoscope. "Micro" refers to getting a very close (magnified) view of the area to see every tiny detail. This can be done with a special telescope or operating microscope.


What are the indications for Microlaryngoscopy?
Microlaryngoscopy is especially useful for conditions in which evaluation or treatment of the vocal cords or immediate surrounding airway needs to be performed.

	Nerve or structural injury
	Voice problems, such as a hoarse voice, weak voice or no voice
	Throat pain
	Bloodstained saliva or sputum
	Difficulty in swallowing
	A sensation of a lump in the throat
	Injuries to the throat
	Narrowing of the throat
	Obstructions or masses in the throat
Surgical procedures during the microlaryngoscopy include:
	Removing foreign objects
	Taking a biopsy, which is a small tissue sample
	Removing polyps from the vocal cords
	Performing laser treatment, which uses a tiny intense, focused beam of light to cut tissue.

What happens before the procedure?
When microlaryngoscopy is performed in the operating room, it is usually done with the patient asleep (general anaesthesia). You should tell your anaesthesiologist of any problems you have had in the past or any concerns you have about having anaesthesia. In particular, if you have had trouble with nausea or vomiting in the past, your anesthesiologist will adjust your medications to decrease the chance of stomach acid irritating your vocal folds as it comes back up.


What is involved with Microlaryngoscopy?
With the head tilted back (to make the airway as straight as possible), a laryngoscope is placed in the mouth to look at the larynx (voice box). It also pushes the tongue out of the way. If the patient is old enough to have upper teeth, they are protected with a tooth guard. The involved area is then visualized and the view is magnified (enlarged) using an endoscope (telescope). This is usually attached to a small video camera.

Procedures that may be performed during microlaryngoscopy are numerous, and include removal of polyps or masses on or around the vocal cords or to correct deformities of the vocal cords themselves. These procedures involve the use of special tools and techniques and may include use of the CO₂ laser.

The length of surgery depends on the reason the procedure is being performed (to simply evaluate the area, or to actually remove bumps or masses). The procedure usually does not last more than an hour.

How will I feel after the operation?
After microlaryngoscopy you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts for a day or two.

Some patients feel their neck is slightly stiff after the operation. If you have a history of neck problems, you should inform the surgeon before the operation.

You can usually eat and drink later on the same day. You should be able to use your voice as normal after the procedure. However, if the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period.

When can I go home?
Often you can go home on the same day, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation.

You may be advised to stay off work for a few days to rest your throat.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure.

The risks/complications include:
	Injury to the lips, teeth, gums or tongue. Dental injury may result in teeth being chipped, broken or dislodged. Crowns may also be dislodged.
	Swelling of the tissues of the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth and support with breathing until the swelling resolves. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
	Bleeding into the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth, until the bleeding is controlled. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
	Collapsed lung (Pneumothorax). A small hole in the surface of the lung. Air then leaks from the lung, causing the lung to collapse. The lung may come back up by itself, or a tube may be needed to be put into the chest through the skin, to remove the air around the lung. This may need a longer hospital stay.
	Voice change. The larynx (voice box) or the nerves controlling the larynx may be injured by the instruments used for the microlaryngoscopy. Voice change may also result from excision or biopsy of the abnormal tissue in the larynx. The voice change may be persistent and not respond to further treatment.
	Persistence or recurrence of the original disease may occur.
	Undiagnosed neck/spinal problems

What is ear fluid?
Fluid is normally produced in the middle ear (the space behind the eardrum) in small amounts. Usually the fluid drains out of the ear though the Eustachian tube into the back of the nose. Ear fluid can cause a problem when it builds up in the middle ear. This condition is called otitis media with effusion, or secretory otitis media.

What causes ear fluid to build up in the middle ear? After an ear infection, the Eustachian tube may be temporarily blocked and fluid will build up in the middle ear space instead of draining out normally. After taking antibiotics for the ear infection, the patient may have fluid left in the middle ear, but it is no longer infected fluid.

If there is fluid in the middle ear, the patient will probably have:

• a full, congested sensation in the ear
• mildly reduced hearing (temporary)

There is no earache or fever.

How long will it last?
Because the middle ear fluid clears up by itself in 90% of patient, no treatment is needed for most of them. The fluid will slowly go away.

• By 1 month, 50% of patients will still have fluid.
• By 2 months, 20% of patients will still have fluid.
• By 3 months, only 10% of patients will still have fluid.

If fluid is still there in the ear after 3 to 4 months, the patient will probably need ventilation tubes or special medicines because the fluid will most likely not clear up by itself.

If fluid is still there in the ear after 3 to 4 months, the patient will probably need ventilation tubes or special medicines because the fluid will most likely not clear up by itself..

What is the treatment?
1. Most patients with middle ear fluid have a mild hearing loss (20 to 30 dB). If the patient temporarily loses hearing before age 2, it can interfere with normal speech development. Although the fluid will probably be cleared within 1 to 2 months, treatment is required to help the child deal with limited hearing. Keep in mind that most children's speech will catch up following a brief period of incomplete hearing. When you talk with your child:

• Get close to your child, get eye contact and get his full attention. Occasionally check that he/she understands what you have said.
• Speak in a louder voice than you normally use. A common mistake is to assume your child is ignoring you when actually he doesn't hear you.
• Reduce any background noise from radio or television while talking with your child.
• If your child goes to school, be sure he/she sits in front, near the teacher. Middle ear fluid interferes with the ability to hear in a crowd or classroom.

2. Restrictions: The child will not have any restrictions because of ear fluid. He/she can go outside and does not need to cover the ears. Swimming is permitted unless there is a perforation (tear) in the eardrum, ear tubes or drainage from the ear. Air travel or a trip to the mountains is safe; just have the child swallow fluids, suck on a pacifier or chew gum during descent.

3. Medicines: No medicine is needed unless the patient has allergies or an ear infection.

4. Ear re-check: The patient needs to be checked again to be sure the ear fluid doesn't last longer than 3 months and that it doesn't affect speech development in the child.

How can I help prevent ear infections?
As long as there is fluid in the middle ear, the patient is at risk for having another ear infection. The following list includes ways to help prevent getting ear infections.

• Avoid tobacco smoke. Protect the patient from second hand tobacco smoke. Passive smoking increases the frequency and severity of infections.
• Avoid excessive colds. During the first year of life, reduce the child’s exposure to people with colds. Most ear infections start with a cold. Try to delay the use of large day care centres during the first year by using a sitter in the home or a small home-based day care.
• Breast-feed. Breast-feed your baby during the first 6 to 12 months of life. Antibodies in breast milk reduce the rate of ear infections.
• Avoid bottle propping. If you bottle-feed, hold your baby at a 45-degree angle. Feeding in the horizontal position can cause formula and other fluids to flow back into the eustachian tube. Allowing an infant to hold his own bottle also can cause milk to drain into the middle ear. Weaning your baby from a bottle between 9 and 12 months of age will help stop this problem.
• Control allergies. If your infant has a continuously runny nose, consider allergy as a contributing factor to the ear infections. If your child has other allergies such as eczema, your physician will check for a milk protein or soy protein allergy.
• Adenoids. If your toddler constantly snores or breathes through his mouth, he may have large adenoids. Large adenoids can contribute to ear infections. Talk to your physician about this.

Consult a doctor If:

• Your child develops an earache.
• Your child's speech development is delayed.
• You have other questions or concerns.

What is a "Myringoplasty"? A myringoplasty is a surgical procedure indicated as a treatment option for a perforated eardrum when the perforation has failed to heal on its own. It involves using a piece of grafted skin taken from another part of the anatomy and placing and securing it over the hole.

What causes a perforated ear drum?
Perforation of the ear drum can occur following an infection of the ear where fluid and infectious material has collected, resulting in a split or tear to the ear drum. Other possible reasons for a perforation of the eardrum include trauma following insertion of a foreign body or cleaning implement into the ear, sudden changes in atmospheric air pressures when the ear cannot equalize its own pressures quickly enough or because of exposure to sudden noises.

Why do I need an operation?
In most cases of eardrum perforation, the hole will simply seal itself and no long-term effects are experienced. If this does not happen however, the hole remains open, leaving the ear vulnerable to further infections, which may potentially be very serious if left untreated.

What improvements can I expect from a myringoplasty? This varies a lot from person to person and depends on what symptoms you have to start with. Possible benefits include:

• You may get a mild improvement in your hearing.
• you are less likely to get middle ear infections when you get your ears wet
• less ear discharge

Are there any alternatives?
You cannot take tablets or medicines to close a hole in your eardrum. Sometimes, small holes close by themselves if left. If not, then a surgery is a must.

Preparation for surgery:
A few weeks before the operation, you will be contacted by the hospital with a date and time for the operation. You will be told about when to stop eating and what to bring to hospital.

You will have a chance to further discuss the risks and then will be asked to sign a consent form. If you smoke, you should aim to stop at least 24 hours before your operation. If you decide you don’t want the operation, you should contact your doctor.

What is involved in the operation?
Performed under a general anaesthetic, the surgeon selects the best piece of skin for the graft; this is usually taken from just above the ear itself. This area will then be stitched using either absorbable material that will dissolve by themselves or with non-absorbable material that will be removed approximately seven days following the surgery.
Using very small instruments, the surgeon then places this graft onto the underside of the eardrum and secures it using an adhesive substance that will hold the graft in place until it has attached itself to the new surface. The ear may then be packed with some gauze soaked in anti-biotic drops used to help prevent an infection and the whole ear is then protected using a cotton dressing.
If the operation has been successful and there have been no complications, discharge can be expected 24 to 48 hours later. The surgeons who perform this operation should be highly trained and will be confident and competent that they can carry it out.

What to expect after the surgery? Following the operation, expect some discomfort from the packing, along with hearing impairment whilst the dressings are in place. Pain can be controlled using prescribed drugs or with Paracetamol. Try not to blow your nose or allow water to enter your ears until the packing has been removed. The packing will normally be removed during a follow-up appointment around three weeks later, when the eardrum will be assessed.
At Home:

• Take two pain-killing tablets every six hours to control any pain or discomfort.
• Be sure to keep the ear dry and do not go swimming.
• Avoid flying until the doctor confirms that the graft has successfully closed the hole. This is because changes in the ear pressure especially during take off and landing can push the graft out of place.
• You may feel rather tired for a week or so, but this will steadily improve. You should be able to go back to work after 10 days, but you must keep your ear dry.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure.
Below are some of the risks /complications:

• Bleeding or infection in the ear or in the wound.
• Failure of the repair. Persistence of the tympanic membrane perforation may occur and may require further surgery.
• Recurrence of the tympanic membrane perforation may occur and may require further surgery.
• Cholesteatoma.
• Ringing (tinnitus) or imbalance/dizziness may occur temporarily or permanently.
• Failure to improve hearing: An improvement in hearing may not be apparent despite the surgery being successful in repairing the hole.
• Altered sensation of taste may occasionally occur on one side.
• Sensation to the ear (pinna) or the ear may stick out.
• Partial loss of hearing or total loss of hearing may rarely occur.
• Temporary or permanent paralysis of the muscles of the face may rarely occur.
• In some people, the wound can become thick and red and the scar may be painful

Your child's sinuses are not completely developed until he is 20 years old. Although small, the maxillary (behind the cheek) and ethmoid (between the eyes) sinuses are present at birth. Unlike in adults, paediatric sinusitis is difficult to diagnose because symptoms can be subtle and the causes - complex.

How do I know when my child has sinusitis?
The following symptoms may indicate a sinus infection in your child:

• a "cold" lasting more than 10 to 14 days, sometimes with a low-grade fever
• thick yellow-green nasal drainage
• post-nasal drip, sometimes leading to or exhibited as sore throat, cough, bad breath, nausea and/or vomiting
• headache, usually not before he is 6 years old
• irritability or fatigue
• swelling around the eyes

Young children have immature immune systems and are more prone to infections of the nose, sinus, and ears, especially in the first several years of life. These are most frequently caused by viral infections (colds), and may be aggravated by allergies. However, when your child remains ill beyond the usual week to ten days, a serious sinus infection is likely.
You can reduce the risk of sinus infections for your child by reducing exposure to known environmental allergies and pollutants such as tobacco smoke, reducing his/her time at day care and treating stomach acid reflux disease.

How will the doctor treat sinusitis?
Acute sinusitis
Most children respond very well to antibiotic therapy. Nasal decongestants or topical nasal sprays may also be prescribed for short-term relief of stuffiness. Nasal saline (salt water) drops or gentle spray can be helpful in thinning secretions and improving mucous membrane function. If your child has acute sinusitis, symptoms should improve within the first few days. Even if your child improves dramatically within the first week of treatment, it is important that you continue therapy until all the antibiotics have been taken and visit your doctor before stopping the medication. Your doctor may decide to treat your child with additional medicines if he/she has allergies or other conditions that make the sinus infection worse.

Chronic sinusitis
If your child suffers from sinus symptoms that last for twelve weeks, two major symptoms or one major symptom and two minor symptoms, it is known as chronic sinusitis. If your child has chronic sinusitis or recurrent episodes of acute sinusitis numbering more than four to six per year, you should seek consultation with an ear, nose and throat (ENT) specialist. The ENT may recommend surgical treatment of the sinuses. Diagnosis of sinusitis
If your child sees an ENT specialist, the doctor will examine his/her ears, nose and throat. A thorough history and examination usually leads to the correct diagnosis. Occasionally, special instruments will be used to look into the nose during the visit. An X-ray or a CT scan may help to determine how the child's sinuses are formed, where the blockage has occurred and the reliability of a sinusitis diagnosis.

When is surgery necessary?
Surgery is considered for the small percentage of children with severe or persistent sinusitis symptoms despite medical therapy. Using an instrument called endoscope, the ENT surgeon opens the natural drainage pathways of your child's sinuses and makes the narrow passages wider. This also allows for culturing, so that antibiotics can be directed specifically against your child's sinus infection. Opening up the sinuses and allowing air to circulate usually results in a reduction in the number and severity of sinus infections.
Also, your doctor may advise removing adenoid tissue from behind the nose as part of the treatment. Although the adenoid tissue does not directly block the sinuses, infection of the adenoid tissue called adenoiditis or obstruction of the back of the nose, can cause many of the symptoms that are similar to sinusitis, namely, runny nose, stuffy nose, post-nasal drip, bad breath, cough and headache.

What is the "nasal septum"? The nasal septum is the partition inside the nose that separates the two nostrils. It is a vertical wall that divides the right nasal cavity from the left nasal cavity. It is made of gristle (cartilage) in the front and bone at the back. Usually the septum is straight, upright and in the middle of the nose.

What is "Septoplasty"?
Septoplasty is a surgical procedure to correct the shape of the septum of the nose. The goal of this procedure is to treat defects or deformities of the septum. Septal deviations are either congenital (present from birth) or develop as a result of an injury. Most people with deviated septa do not develop symptoms. It is typically only the most severely deformed septa that produce significant symptoms and require surgical intervention.



Why is it done?
The main reasons for this surgery are:

• Nasal airway obstruction: Nasal airway obstruction is usually the result of a septal deformity. Persons with this condition usually breathe by mouth and have sleep apnea and recurrent nasal infections.
• Septal spur headache: Headache caused by pressure from the inside of the nose (septal impaction), which goes away when a numbing medicine (anesthetic) is placed on the area.
• Uncontrollable nosebleeds
• Deformity of the nasal septum
• People who snort drugs such as cocaine in large quantities for long periods of time may require septoplasty if drug use has damaged the septum.

Benefits:
Straightening out your septum will improve your nasal breathing and reduce any related problems with your sinuses and ears. Any headaches or pain caused by the bent septum will be treated by this.

Are there any alternatives?
Nasal drops, sprays or tablets will not remove an obstruction caused by a bent nasal septum. Medication improves nasal breathing, but problems return when the treatment stops. Using nasal drops for a long time may actually damage the lining of the nose (mucosa) and make the blockage worse. The only way to repair a deviated nasal septum is through surgery.

Preparation:
Before performing a septoplasty, the surgeon will evaluate the difference in airflow between the two nostrils. In children, this assessment can be done by asking the child to breathe out slowly on a small mirror held in front of his/her nose. Patients are evaluated for any physical conditions that might complicate surgery and for any medications that might affect blood clotting time. If a general anesthetic is used, the patient is advised not to drink or eat after midnight, the night before the surgery. In many cases, septoplasty can be performed on an outpatient basis using local anesthesia.


What happens during the procedure?
A cut is made inside the wall of one side of the nose. The mucous membrane is lifted and anything that is blocking the area is removed or repositioned as necessary. Then, the mucous membrane is returned to its original position. The tissues covering the wall are held in place by either stitches or packing.

Aftercare:
The operation usually takes 30 to 45 minutes. Patients who undergo septoplasty are usually discharged on the same day or the next morning, after the surgery. All dressings inside the nose are usually removed before the patient leaves.

• The head needs to be elevated while resting during the first 24-48 hours after surgery.
• Patients will have to breathe through the mouth while the nasal packing is still in place.
• A small amount of bloody discharge is normal but excessive bleeding should be reported to the physician immediately.
• Antibiotics are usually not prescribed unless the packing is left for more than 24 hours.
• Most patients do not experience significant amounts of pain, but patients with severe pain are sometimes given narcotic pain relievers.
• Patients are often advised to place an ice pack on the nose to enhance comfort during the recovery period.
• Patients who have splint placement usually return seven to 10 days after the surgery for examination and splint removal.

What are the do's and don'ts after Septoplasty?

• Allow yourself to feel more tired than usual for 1-2 weeks.
• You may find mild painkillers such as Paracetamol helpful - avoid painkillers containing aspirin.
• You will be sleeping with your mouth open as your nose will feel blocked - drink plenty of fluids to stop dehydration. If feeling uncomfortable, you may find a straw helpful.
• Alleviating your neck with extra pillows while sleeping may make your nose feel less blocked and make you more comfortable.
• Avoid smoky environments.
• Do not blow your nose or stifle sneezing for the first week - you may sniff gently and dab or wipe the nose carefully.
• Do not travel for two weeks by boat or plane if you do not have access to medical care. Significant bleeding during this period is rare but there is a possibility it could happen.
• Avoid physical exertion such as heavy gardening, running or the gym for 2 weeks and resume gently after this period. You may swim after 2 weeks but avoid if this risks your nose being accidentally knocked.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However, it is important that you are aware of the complications/risks that may arise out of this procedure. The risks and complications include:

• Bleeding: This may occur either at the time of surgery or in the first few weeks after surgery. Bleeding after surgery may require packing of the nose under local anaesthesia or may require another operation to stop the bleeding. A blood transfusion may be necessary depending on the amount of blood lost.


• Infection: Infection may require antibiotics and may cause bleeding.


• Persistence or recurrence of the original problem with an unsatisfactory cosmetic appearance or lack of satisfaction with the new cosmetic appearance of the nose.


• Abnormal healing of external wounds with abnormal scar formation.


• Impaired or lost sense of smell and taste.


• Adhesions or scar tissue forming inside the nose requiring further surgery.


• Numbness of the top lip and/or upper front teeth.


• CSF leaks/Orbital Hematoma (bruising)/Septal Abscess/Hematoma


• May increase snoring or sleep disturbance.

What is sinusitis?
Sinusitis is swollen or infected linings of the sinuses. The sinuses are hollow spaces in the bones of your face and skull. They connect with the nose through small openings. Like the nose, they are lined with membranes that make mucus



How does it occur?
Sinusitis occurs when the sinus membranes swell or are infected. The passageways between sinuses and the nose are very narrow. Swelling of the sinus linings causes them to produce large amount of mucus. The swelling and the extra mucus may block the passageways. This leads to pressure changes in the sinuses that can be painful.

A number of different irritants can cause swelling and sinusitis. Sinusitis often occurs after a cold, but not always. Bacteria, viruses, allergies and even fungus can cause sinusitis.

If your nasal bones have been injured or are deformed, causing partial blockage of the sinus openings, you are more likely to get sinusitis.

What are the symptoms?
Symptoms include:

• Feeling pressure in the head
• Headache that is most painful when you first wake up in the morning and when you bend your head down or forward
• Tenderness above, behind or below your eyes
• Ache in the upper jaw and teeth
• Runny or stuffy nose
• Cough, especially at night
• Fluid draining in the back of your throat (post-nasal drainage)
• Sore throat in the morning or evening

How is it diagnosed?
Your doctor will ask about the symptoms and will examine you. You may have an X-ray to look for swelling, fluid or small benign growths (polyps) in the sinuses.

How is it treated?
Generally the doctor prescribes an antibiotic or decongestants for several weeks. Medicine for pain, such as Acetaminophen or Aspirin, can also be used.

Antihistamines or nasal sprays (steroids or cromolyn) are used to treat the allergies that cause chronic (recurrent) sinus infections.

Surgery is applied to treat chronic, severe sinusitis that does not respond to the medicines. The surgeon creates an extra or enlarged passageway in the wall of the sinus cavity. This allows the sinuses to drain more easily through the nasal passages and help them stay free of infection. This allows the sinuses to drain more easily through the nasal passages. This should help them stay free of infection.

How long will the effects last?
Symptoms may improve gradually over 3 to 10 days. Depending on what caused the sinusitis and how severe it is, it may last for days, weeks or months.

How can I take care of myself?
Follow your doctor's instructions. Avoid smoke. If you have allergies, avoid the things you are allergic to, such as animal dander. Add moisture to the air with a humidifier or a vaporizer, unless you have mold allergy. Inhale steam from a basin of hot water or shower to open your sinuses and relieve pain. Use decongestants as directed. Generally nasal spray decongestants should not be used for more than 3 days. After 3 days, they may cause your symptoms to get worse. Get plenty of rest and drink a lot of water. Put warm compresses on painful areas. Take antibiotics as prescribed. Use all of the medicine, even if you feel better. See your doctor, if the pain lasts for several days. If the sinus areas above or below your eyes are swollen or bulging, see your health care provider right away.

How can I help prevent sinusitis?
Treat your colds and allergies promptly. Use decongestants as soon as you start having symptoms. Do not smoke. Drink lots of fluids. Humidify your home if the air is particularly dry. If sinusitis continues to be a problem despite treatment, you need to be checked for polyps or a deformed bone that may be blocking your sinuses.

What is Functional Endoscopic Sinus Surgery?
Functional endoscopic sinus surgery requires no incisions on the face but utilizes "telescopes" which are long thin rods of glass wrapped with stainless steel providing illumination and visualization in the nose and sinus pathways. Instruments, designed solely for the purpose of FESS, are used along with the telescopes for the operation. The operation enlarges the drainage pathways of the sinuses by preventing the build-up of mucus and pus in the sinuses.

The operation may be performed under general anaesthesia and a machine supporting your breathing or under sedation involving the administration of local anaesthesia. The doctor's preference may vary depending on the situation.

The operation takes approximately 1- 3 hours depending on the extent of surgery. Sometimes an overnight hospital stay is required. Pain tends to be of the dull achy variety and is well treated with pain medication. Packing is needed for 24-48 hrs, when you need to breathe through the mouth. Commonly your nose will feel stuffy and congested for several days following the operation. If your doctor has had to repair your septum at the same time, splints may be required which may remain in the nose for about a week. They are simply removed at the first follow-up clinic visit.

How is Functional Endoscopic Sinus Surgery different from conventional sinus surgery?
One difference between functional endoscopic sinus surgery and conventional sinus surgery is that an endoscope is used in the nose to view the nasal cavity and sinuses. This generally eliminates the need for an external incision. The endoscope allows for better visualization of diseased or problem areas. This endoscopic view, along with detailed X-ray studies, may reveal a problem that was not evident before.

Another difference is that functional endoscopic sinus surgery focuses on treating the underlying cause of the problem. The ethmoid areas are usually opened, which allows visualizing the maxillary, frontal and sphenoid sinuses. The sinuses can then be viewed directly, and diseased or obstructive tissue removed, if necessary. There is often less removal of normal tissue and the surgery can frequently be performed on an outpatient basis.

When is Endoscopic Sinus Surgery Indicated?
Endoscopic sinus surgery is generally intended for people with chronic sinus problems, who do not respond to medical therapy. The diagnosis of chronic sinusitis must be based on an assessment by the doctor, as other problems can cause symptoms similar to those found in sinus disease. The majority of people with sinusitis do not require surgery. Their sinus symptoms can usually be successfully treated medically, including antibiotic therapy and other medications, treatment of allergy and environmental control. The type of medical therapy used is based on the doctor's assessment.

However in some people, surgical intervention is required. This is because an infected or inflamed area does not clear with antibiotic therapy or other medications, the symptoms continue returning when antibiotics are stopped or for other reasons. You should discuss the need for sinus surgery with your doctor.

How am I evaluated/scheduled for Endoscopic Sinus Surgery?
The decision to have a sinus surgery will be based on your history and physical exam. At the initial consultation, it is important to bring records from your doctor including all treatment history. If a previous CT scan or MRI is available, it should also be brought during your first visit. A CT scan is required to accurately assess the areas involved. If not done prior to your visit, one will need to be done at a later time.

Medical therapy may be initiated, based on your evaluation, to see how you respond to maximal medical treatment before deciding on a surgical procedure. If it would benefit you, your consent will be obtained and a date will be arranged for the procedure.

How Do I Prepare for Surgery?
Prior to surgery, you need to undergo some blood tests and possibly some other studies, such as, ECG and chest X-ray will be performed, if your age or medical history indicates a need. To be current, blood tests should be done within one month of surgery.

Typically, you will have a visit to be re-examined prior to surgery. If you have a CT scan from outside this institution, bring it with you during this visit. Surgery will not be performed without the CT scan.

In some cases, starting oral steroids (or increasing the dose if you are already on them) and/or antibiotic therapy is done in the pre-surgical period. If you have a significant increase in your sinus infection in the week(s) prior to surgery, then notify the doctor. Your surgery may need to be postponed.

• Do not take aspirin or salicylate containing analgesics for at least ten days prior to surgery. Aspirin, even in small quantities, can significantly increase bleeding during surgery and post-operatively.
• Do not take non-steroidal, anti-inflammatory drugs for at least five days prior to surgery. These drugs will also increase bleeding, although the effects are shorter.
• Do not smoke for at least three weeks prior to surgery. Not only does smoking worsen sinus symptoms, smoking during the weeks before or after surgery will result in excessive scarring, and may result in failure of the operation.
• Do not eat or drink anything beginning at midnight, the night before surgery. If you are taking medications, ask during your pre-surgical evaluation if these can be taken on the morning of surgery.
You should obtain some Afrin nasal spray from your pharmacy, and spray into the nose one to two hours prior to the operation.

What Will Happen During Surgery?
The surgery is typically not uncomfortable and should not be an unpleasant experience. The operation can be performed under general or local anaesthesia, with an anaesthesiologist providing monitored sedation. Your physician will discuss the advantages/disadvantages of each type, and together you will decide which is right for you. Although there are potentially serious risks from surgery in this area, the incidence of these risks is very low.

If you choose local anaesthesia, you will be given medication to make you sleepy and relaxed, and will be provided with some headphone music. You will usually hear some crunching sounds as bone is removed which may sound loud to you. You may also feel some mucus or blood in the back of your throat that you should swallow. You will be able to talk to us during the surgery, so let us know if anything bothers you. Should you experience significant discomfort during the procedure, we will provide monitored sedation.

In some cases, it may be necessary to repair the nasal septum at the time of sinus surgery. If this is required, additional risks associated with septal repair are possible.

What Are the Risks of Endoscopic Sinus Surgery?
Bleeding

Although the risk of bleeding appears to be reduced with this type of sinus surgery, on occasion of significant bleeding, termination of the procedure and the placement of nasal packing may be required. Bleeding following surgery could require placement of nasal packing and hospital admission. A blood transfusion is very rarely necessary.

Blood Transfusion

In the rare instance that a blood transfusion is necessary, there is a risk of adverse reaction or the transfer of infection.

Cerebral Spinal Fluid (CSF) Leak

All operations on the ethmoid sinus carry a rare chance of creating a leak of CSF (the fluid that surrounds the brain). The risk of CSF leak is generally considered higher when ethmoid surgery is done through the nose, instead of by external incision. However, because the endoscope used allows for improved visualization, the risk of this complication is potentially reduced. Should this rare complication occur, it creates a potential pathway for infection, which could result in meningitis (inflammation of the brain). A CSF leak would extend your hospitalization and may require further surgery for repair.

Visual Problems

Although extremely rare, there are occasional reports of visual loss after sinus surgery. Usually, the loss of vision only involves one side and the chance for recovery is not good. Temporary or prolonged double vision has also been reported after sinus surgery.

Anaesthesia Risks
Because endoscopic sinus surgery is typically performed under local anaesthesia, adverse reactions are uncommon. If general anaesthesia is required, you would have occasional but possibly serious risks involved. Adverse reactions to general anaesthesia may be further discussed with the anaesthesiologist.

Nasal Septum Reconstruction Risks
If nasal septal reconstruction is done, you could experience numbness of the front teeth, bleeding and infection in the nasal septum, or the creation of a septal perforation. A septal perforation is a hole through the septum, which may cause difficulty breathing through the nose. Since the cartilage in the septum has a “memory,” it may shift post-operatively and result in a renewed deviation. There is also a small risk of a change in shape of the nose.

Decreased Sense of Smell
Permanent loss or decrease in the sense of smell can occur following surgery. However, in a number of patients, it is already decreased prior to surgery, and typically improves with surgical intervention.

Other Risks
Tearing of the eye can occasionally result from sinus surgery or sinus inflammation and may be persistent. You may experience numbness or discomfort in the upper front teeth for a period of time. Swelling, bruising, or temporary numbness of the lip may occur, as well as swelling or bruising around the eye. Subtle changes in the sound of your voice are common.

While the techniques of FESS have been shown to provide long-lasting symptomatic relief for chronic sinusitis, the surgery is designed to address only areas that are involved with the disease. If the disease has developed over time, additional sinus surgery is required in the future, again utilizing FESS techniques.

What to expect after the operation
You will be in the recovery room after you wake up from anaesthesia. Your nose will be stuffy and achy. Packing is needed for 24-48 hrs, when you need to breathe through the mouth. You may have a dressing under your nose to collect the occasional bloody drip that is normal for the first 24-48 hours after surgery. You will experience some dull ache around your nose and sinus cavity that should be well treated with pain medication prescribed for you.

You will be sent home with prescriptions for pain medication, an antibiotic pill and possibly with steroid pills. It is extremely important to take the prescribed antibiotic pill, as serious infection could result if not taken.

You should keep your nose moist with a salt water nasal spray (Sinomarin) or possibly with an irrigation solution for the first week, following the operation. Your first follow-up will be approximately after one week, during which the nose will be cleaned in the clinic under local anaesthesia (sprays). The procedure may need to be repeated weekly for the first 4-6 weeks, following the surgery. For the first two post-operative visits, it is recommended that you take pain medication prior to your arrival.

Usually at your first follow-up visit, steroid sprays will be restarted (Rhinocort Aqua etc.). Antibiotics will be continued until the cavity is healed, usually for 3-4 weeks. Similarly, if steroid pills are prescribed, these will be slowly discontinued over three to four weeks.

Post- Operative Instructions
1. Change the pad under your nose as needed for the first 24-48 hours following the surgery. Bloody drainage is normal during that time. Consult your doctor if you have excessive (flowing) bleeding.
2. Keep nose moist with over-the-counter salt water spray.
3. Minimize your activities and avoid working for about one week following the procedure, even if you feel well!
4. Take a pain pill prior to your arrival for your first post-operative visit. Bring someone with you to drive as appropriate.

Will Endoscopic Sinus Surgery cure my Sinus problems?
As with all sinus surgery, it is possible that the disease may not be cured by the operation or that disease may recur at a later time. If this should happen, subsequent surgical therapy may be required. It should be realized that some medical therapy is usually continued after surgery, especially if allergy or polyps play a role in the sinus disease. This is necessary to prevent recurrence of disease.

Overall, the majority of patients have had significant improvement with the combination of surgery and continued medical managements.

What is "Stapedectomy"?
Stapedectomy is a surgical procedure in which the innermost bone (stapes) of the three bones (the stapes, the incus and the malleus) of the middle ear is removed and replaced with a small plastic tube of stainless-steel wire (a prosthesis), to improve the movement of sound to the inner ear.

Why is it done?
A stapedectomy is used to treat progressive hearing loss caused by otosclerosis, a condition in which spongy bone hardens around the base of the stapes. This condition fixes the stapes to the opening of the inner ear, so that the stapes no longer vibrates properly; therefore, the transmission of sound to the inner ear is disrupted. Untreated otosclerosis eventually results in total deafness, usually in both ears.

How does one prepare for surgery?
Prior to admission to the hospital, the patient will be given a hearing test to measure the degree of deafness, and a full ear, nose and throat exam.

What happens during the surgery?
With the patient under local or general anaesthesia, the surgeon opens the ear canal and folds the eardrum forward. Using an operating microscope, the surgeon is able to see the structures in detail, and evaluates the bones of hearing (ossicles) to confirm the diagnosis of otosclerosis.

Then the surgeon separates the stapes from the incus; freed from the stapes, the incus and malleus bones can now move when pressed. A laser (or other tiny instrument) vaporizes the tendon and arch of the stapes bone, which is then removed from the middle ear.

The surgeon then opens the window that joins the middle ear to the inner ear and acts as the platform for the stapes bone. The surgeon directs the laser's beam at the window to make a tiny opening and gently clips the prosthesis to the incus bone. A piece of tissue is taken from a small incision behind the ear lobe and used to help seal the hole in the window and around the prosthesis. The eardrum is then gently replaced and repaired, and held there by absorbable packing ointment or a gelatin sponge. The procedure usually takes about an hour and a half.

Who can undergo the surgery?
People who have a fixed stapes from otosclerosis, and a conductive hearing loss of at least 20 dB, require surgery. Patients with a severe hearing loss might still benefit from a stapedectomy, if it is only to improve their hearing to the point where a hearing aid can be of help. The procedure can improve hearing in more than 90% of cases.

Aftercare:
The patient is usually discharged in the morning after surgery. Antibiotics are given for five days after surgery to prevent infection; packing and sutures are removed about a week after the surgery.

Precautions:
It is important that the patient does not put pressure on the ear for a few days after surgery. Blowing one's nose, lifting heavy objects, swimming underwater, descending rapidly in high-rise elevators or taking an airplane flight, should be avoided. Right after surgery, the ear is usually quite sensitive, so the patient should avoid loud noises until the ear retrains itself to hear sounds properly.

It is extremely important that the patient avoids getting the ear wet until it has completely healed. Water in the ear could cause an infection; most seriously, water could enter the middle ear and cause an infection within the inner ear, which could then lead to a complete hearing loss. When taking a shower or washing the hair, the patient should plug the ear with a cotton ball or lamb's wool ball, soaked in Vaseline. The surgeon should give specific instructions about when and how this can be done.

When can the patient resume normal activities?
Usually, the patient may return to work and normal activities about a week after leaving the hospital. If the patient's job involves heavy lifting, three weeks of home rest is recommend. Three days after surgery, the patient may fly in pressurized aircraft.

Normal results:
Most patients are slightly dizzy for the first day or two after surgery, and may have a slight headache. Hearing improves once the swelling subsides, the slight bleeding behind the ear drum dries up, and the packing is absorbed or removed, usually within two weeks. Hearing continues to get better over the next three months.

Prognosis:
About 90% of patients have a completely successful surgery, with markedly improved hearing. In 8% of cases, hearing improves, but not quite as patients usually expect. About half the patients who experience ringing in the ears (tinnitus) before surgery will have significant relief within six weeks after the procedure.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure.

The risks/ complications include:

• Total loss of hearing (complete and irreversible loss of hearing in the operated ear i.e. dead ear). This occurs usually due to the complications arising during the operation or during post-operative period, despite the operation being uneventful.



• Partial loss of hearing where the hearing is worse after the operation. This occurs usually due to the complications arising during the operation, and may also occur during post-operative period despite the operation being uneventful.



• Failure to improve hearing, where there is no improvement in hearing after the operation. This may occur despite the operation being uneventful and may also be due to another disease involving the bones in the middle ear.



• Altered sensation of taste. The nerve carrying taste fibres on the same side of the tongue may need to be divided (cut) or stretched to obtain access to the stapes bone resulting in an altered taste, which may be temporary or permanent.



• Ringing in the ear (tinnitus). Otosclerosis is often associated with tinnitus. In some cases the tinnitus may be worse after surgery and may be temporary or permanent.



• Dizziness or imbalance may occur and may be temporary or permanent.



• Bleeding or infection in the ear or in the wound.



• Facial nerve palsy. Temporary or permanent paralysis of the muscles of the face may rarely occur.



• Perforation of the tympanic membrane (ear drum) may rarely occur and may require further surgery to repair the perforation.

What are the "Tonsils"?
The tonsils are two oval lumps of tissue. They sit on either side of the back of your throat, behind your tongue. The tonsils are involved in helping your body fight infection but they are not essential to your health.

What is "Tonsillectomy"?
A tonsillectomy is an operation to remove the tonsils. The operation is necessary for people who get repeated or very severe bouts of tonsillitis that interfere with normal life.

Why to have a tonsillectomy?
Sometimes the tonsils can become infected, either with a virus or with bacteria, causing symptoms such as a sore throat, painful swallowing, headache and fever. This is called tonsillitis.

The majority of people who get tonsillitis do not need an operation. The surgeon usually suggests it for people who have had:

• at least five bouts of tonsillitis in the past year
• frequent ear infections because of swollen tonsils
• swollen tonsils that make it harder to breathe or swallow
• sore throats that stop you, or your child, getting on with everyday life (such as finding it hard to sleep or your child missing school)

What are the alternatives?
Many children grow out of tonsillitis over a year or so and do not need any treatment at all. There are treatments for tonsillitis that don't involve surgery, such as painkillers to help reduce discomfort. Antibiotics are the only other available treatment that treats sore throats in the long-term.

Sometimes, a long-term course of antibiotics is prescribed to avoid the need for a tonsillectomy. Tonsillitis that is caused by bacteria often responds well to this treatment. However, the most common type of tonsillitis is caused by a virus, and cannot be treated in this way.

Your doctor will discuss the available options with you.

What happens before tonsillectomy?
Your surgeon will instruct you about how to prepare for the operation. It is unlikely that the surgeon will perform a tonsillectomy if a person has an infection. This is because an infection can increase the chance of chest problems. The patient should inform the hospital if he/she has a sore throat or cold in the week before the operation date as it may need to be postponed.

What to expect in hospital
Before surgery you will talk to your surgeon about the operation and you will be asked to sign a Consent Form either for yourself, or on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Fasting instructions must be followed before a general anaesthetic. Typically, you must not eat or drink for about six hours. However, some anaesthetists allow occasional sips of water until two hours earlier.

The operation
The tonsillectomy is often performed under a general anaesthesia. A tonsillectomy generally takes about half an hour and an overnight stay in hospital is usually necessary.

Once the anaesthesia has taken effect, your mouth is held open to see into the throat. No cuts are made in the skin.

There are a number of different methods that your surgeon can use to remove the tonsils.

• The tonsils can be cut away with special scissors. Dissolvable stitches are then used to close the wound and to stop the bleeding.
• Lasers, ultrasound and freezing can also be used to take out tonsils. They are newer methods and aren't commonly used.
• Diathermy - an instrument is heated to a temperature of about 100ºC. The heated instrument cuts away the tonsils and seals up the area where they have been removed from.
• Coblation (or cold ablation) uses a lower temperature (about 60ºC) to cut away the tonsils.

After the operation
As the anaesthesia wears off, you may have a sore throat or pain in your ears, or both, and the jaw may be stiff. Painkillers will be given to help reduce discomfort.

After about 12 hours, a white or yellowish membrane (thin skin) will appear where the tonsils were. It's the new skin growing over the wound.

People are encouraged to begin to drink and eat as soon as they feel ready, starting with clear fluids such as, water or apple juice.

Most patients stay in hospital for one night. In some hospitals tonsil surgery is done as a day-case, which allows the patient to go home on the same day. Either way, the hospital will only let a patient go home when he or she is eating, drinking and feeling well enough to go home.

However, due to the general anesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Recovering from a tonsillectomy
Painkillers can be taken if needed and as advised by your surgeon or nurse.

Soft or liquid foods will be less uncomfortable. Although it may be painful, swallowing solid foods like toast and cereal will help healing by scraping away dead tissue. Taking a dose of painkillers half an hour before meals may help reduce discomfort.

The teeth may be brushed as normal.
It is advisable to stay at home for 7-14 days after the operation, avoiding contact with people who have colds, coughs or other infections. Strenuous activities should also be avoided during this time.

Complete recovery will take about two weeks.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However, it is important that you are aware of the complications/risks that may arise out of this procedure.

The risks/ complications include:

• Bleeding: Either at the time of surgery or in the first 2 weeks after surgery bleeding may occur. Delayed bleeding may require re-admission to hospital and may require another operation to stop the bleeding. A blood transfusion may be necessary depending on the amount of blood lost.


• Burns from the equipment used to seal off bleeding areas during the operation.


• Infection: Persistent bad breath, worsening throat discomfort or delayed bleeding may indicate an infection. This is usually treated with antibiotics. Delayed bleeding is treated as mentioned above.


• Pain: Moderate throat pain is common during the first 2 weeks after surgery, requiring regular analgesia. There may rarely be pain at the back of the tongue or back of the throat.


• Injury to the teeth, lips, gums or tongue: There can also be a temporary change in sensation to tongue.


• Abnormal scarring may rarely occur causing narrowing or stenosis of the throat or strange sensations in the throat.

What are the "Tonsils"?
The tonsils are two oval lumps of tissue. They sit on either side of the back of your throat, behind your tongue. The tonsils are involved in helping your body fight infection but they are not essential to your health.

What is a "Tonsillectomy"?
A tonsillectomy is an operation to remove the tonsils. The operation is necessary for people who get repeated or very severe bouts of tonsillitis that interfere with normal life.

What are the indications for a tympanoplasty?
This procedure is usually not performed (or needed) in children under four years of age. A tympanoplasty is recommended when the eardrum is torn (perforated), sunken in (atelectatic), or otherwise abnormal, and associated with hearing loss. Abnormalities of the ear drum and middle ear bones can occur through injury, otitis media, congenital (at birth) deformities or chronic ear conditions, such as, a cholesteatoma.

What are the signs & symptoms of a ruptured eardrum?
A ruptured eardrum can be painful, particularly at first. Signs and symptoms may include:

• Sharp, sudden ear pain or discomfort
• Clear, pus-filled or bloody drainage from your ear
• Sudden decrease in ear pain followed by drainage from that ear
• Hearing loss
• Ringing in your ear (tinnitus)

How successful is tympanoplasty in restoring normal hearing?
Return to a normal range of hearing after tympanoplasty is dependent upon the extent of the abnormality. Surgeries that involve repair of the eardrum usually have a success rate of 85-90%. A second operation may be necessary in some cases, if the hearing is not restored to an acceptable level.

Are there any other options aside from tympanoplasty?
Tympanoplasty, in most cases, is an elective procedure, meaning that it can be scheduled whenever the patient is ready to have it done. Another option, instead of this procedure, is the use of a hearing aid. When the tympanic membrane has a hole (perforation) in it, earplugs are usually recommended to protect the middle ear from infection. In a few cases, such as a significant infection or a cholesteatoma, this procedure may prevent more significant damage to the ear and the surgery may need to be performed more urgently.

What is done in preparation for a tympanoplasty?
Usually other ear, nose and throat conditions are treated before a tympanoplasty is considered. For example, if an adenoidectomy is indicated, this surgery is usually completed before tympanoplasty.

Otitis media of any type should not be present at the time of surgery, as infections in the ear make the operation much more difficult and may ruin the reconstruction. If your surgeon has suggested certain medications prior to surgery, these should be done without exception to ensure a successful outcome. A hearing test is performed to document any hearing deficiency. The more significant the hearing loss, the sooner the procedure should be performed. The eardrum will also be examined before surgery using a special operating microscope.

What to expect in hospital?
Before surgery, you will talk to your surgeon about the operation and you will be asked to sign a Consent Form either for yourself, or on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Fasting instructions must be followed before a general anaesthetic. Typically, you must not eat or drink for about six hours. However, some anaesthetists allow occasional sips of water until two hours beforehand.

How is Tympanoplasty performed?
A tympanoplasty is performed with the patient fully asleep (under general anaesthesia). A surgical cut (incision) is usually made behind the ear, the ear is moved forward and the eardrum is then carefully exposed. The eardrum is then lifted up (tympanotomy) so that the inside of the ear (middle ear) can be examined. If there is a hole in the eardrum, it is cleaned (debrided) and the abnormal area can be cut away. A piece of fascia (tissue under the skin) from the temporalis muscle (behind the ear) is then cut and placed under the hole in the ear drum to create a new intact ear drum. This tissue is called a graft. The graft allows your child's normal eardrum skin to grow across the hole.

If needed, reconstruction of the middle ear bones (ossiculoplasty) or Cholesteatoma removal may also be performed at this time.

Post operative care:
Some soreness in the jaw is common after a Tympanoplasty. To ease the pain and quicken the healing process, your doctor can advise that you keep the ear dry and avoid air travel and contact with people who have colds. Water in the ear can often cause problems so doctors recommend that you don't take showers, or even walk in the rain for the first 5-6 days. The graft should seal the hole within two weeks.

Length of Tympanoplasty:
This surgery usually requires an overnight hospital stay. The patient usually has a dressing (large bandage) over the surgical site. This is removed the next morning and the patient is discharged home. Occasionally, in older children, or those undergoing a less involved procedure, same-day surgery is possible. Eardrops may be prescribed after discharge.

The most important part of this surgery for the parent is your part in restricting activity as outlined by your surgeon.

What are the risks of the procedure?
While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However, it is important that you are aware of the complications/risks that may arise out of this procedure.

The risks/ complications include:

• Bleeding: Either at the time of surgery or in the first 2 weeks after surgery bleeding may occur. Delayed bleeding may require re-admission to hospital and may require another operation to stop the bleeding. A blood transfusion may be necessary depending on the amount of blood lost.
• Burns from the equipment used to seal off bleeding areas during the operation.
• Infection: Persistent bad breath, worsening throat discomfort or delayed bleeding may indicate an infection. This is usually treated with antibiotics. Delayed bleeding is treated as mentioned above.
• Pain: Moderate throat pain is common during the first 2 weeks after surgery, requiring regular analgesia. There may rarely be pain at the back of the tongue or back of the throat.
• Injury to the teeth, lips, gums or tongue: There can also be a temporary change in sensation to tongue.
• Abnormal scarring may rarely occur causing narrowing or stenosis of the throat or strange sensations in the throat.