Ear Aesthetic Surgery What is Otoplasty?

Kotoplasty is an operation performed in the form of reshaping the ear cartilage, removing or adding some cartilage tissue if necessary. The goal is to create a natural looking ear. Usually the problem is congenital.

How is the Ear Surgery Procedure?

During the operation, a small incision is made behind the ear to reach the cartilage. Depending on the technique to be applied, the cartilage is reshaped and the new shape is permanent with stitches. Symmetry is very important here. After sutures are placed on the skin, the ear is bandaged.

How to Prepare for Ear Surgery?

When evaluating an ear, it is important to look at the ear from different angles. The problem can be hidden when viewed from a single direction. Therefore, the best results are obtained if we perceive the same beauty when viewed from different angles. A beautiful ear should also mean a natural-looking ear. Ear folds should be soft and in harmony with their surroundings. When viewed from the front, the outermost fold of the ear should be seen from the front. The projection of the ear relative to the head should be the same and in harmony in each region.

Correction of the shape of the ear began to gain importance in 1845 with the work of Diffenbach. Luckett brought a new concept to aesthetic ear surgeries in the 1910s, and ear aesthetics in the modern sense began to be performed since the 1960s.

What is Anesthesia Type? How Long Does the Surgery Take?

The procedure takes an average of 60-90 minutes. While ear aesthetics is performed for adults under local anesthesia, general anesthesia is preferred for children.

What Is Done After Ear Surgery?

There may be moderate pain after the operation. This is at a level that can be prevented with medication. If the pain persists for more than 24 hours or gets worse, you should consult your doctor. The wrapped ear bandage is removed in 3-7 days, depending on the situation. From now on, it will be recommended to wear a tennis band to keep and protect the ears in a stable position. It will need to be used for two weeks day and night and additionally two weeks at night only. Sports should not be done for at least 6 weeks. If an ear bandage or tennis bandage is worn and physical contact is not performed, it is possible to return to school or work 2-3 days later.

This operation can be performed at any age, starting from 5-6 years old. After the operation, the ears regain their normal appearance in an average of 1 month.

What Complications May Occur After Surgery?

Collection of blood (hematoma): It is rare. It is the collection of blood between the ear cartilage and the skin. It delays healing and paves the way for infection. When faced with this situation, the accumulated blood is drained and a dressing is applied.

Relapse of the problem: If there is a trauma after the operation or the stitches become loose, the problem may recur. The process is repeated to fix it.

Surgical scar: Traces that may remain behind the ear due to this procedure are not noticed. Sometimes, in front of the ear approaches, a thin line in front of the ear can be seen.

Lack of symmetry: There may be differences in shape and outward projection between the ears. In this case, re-intervention may be required.

Infection: Extremely rare. It should be detected and treated early.

What are the Points to Be Considered After the Surgery?

The applied dressing should be kept clean and dry.

In the first days, activities should be limited. You do not need to restrict daily indoor activities. Excessive activity leads to increased swelling and bruising. Cold and ice application reduces swelling, bruising and pain. If discomfort is felt during ice application, it is appropriate to take a break and apply it.

You should lie down with your head up to reduce swelling. As much as possible, you should not lie on your side for 7-10 days. You should sleep on a very soft pillow for a month.

If you are using glasses, the part of the glasses on the wound should be placed away from the wound.

The dressing will be removed after 3-5 days. After removing the dressing, the ears should not be twisted or pulled.

Excessive exercise and activities should be avoided for 4-6 weeks. It can cause bleeding and swelling.

Inserting a Tube into the Ear

Fluid collection in the middle ear may occur in approximately one-third of children after viral upper respiratory tract infections. This is the result of dysfunction of the Eustachian tube and functional obstruction. In most children, this accumulated fluid is discharged through the Eustachian tube within 15 days to 1 month and the middle ear function improves. In patients where fluid accumulation continues, changes begin to occur in the mucous membrane covering the middle ear and the membrane itself over time. The liquid changes its character and takes on a jelly-like consistency. This leads to hearing loss.

The child may begin to turn up the volume of the television or repeat what the parents have said. If such a situation has arisen, it would be correct to suspect hearing loss and consult a physician.

Cholesteatoma

It usually occurs after middle ear aeration problems experienced in childhood. The outer ear canal skin and eardrum collapse towards the middle ear, gaining a different character and becoming an inflammation-producing tissue. This tissue progresses by eating the middle ear ossicles and the ossicles located in the mastoid region behind the ear. It can progress to the inner ear, causing hearing loss and vertigo problems. Apart from this, if it progresses to the adjacent brain tissue, it can lead to serious life-threatening complications such as meningitis and brain abscess.

The treatment consists of surgically removing this inflamed tissue completely and, in appropriate cases, restoring hearing by repairing the ossicles.

Sometimes this condition may occur congenitally, and in some cases, it may occur due to external ear infections and traumas.

Cochlear Implant (Bionic ear)

They are devices that enable hearing to be reconstructed by placing electrodes directly in the inner ear in patients with severe hearing loss and who cannot benefit from hearing aids. It can be worn in patients with congenital hearing loss until the age of 4, and in patients who have subsequently lost their hearing and learned to speak later, without age restriction. Thanks to this technology, it is possible for individuals who will be born deaf and dumb to learn to speak and live like healthy individuals without hearing loss in society.

Whether a child is a suitable candidate for a cochlear implant is determined after tests and audiological evaluations by expert audiologists.

Otosclerosis

Otosclerosis, known as inner ear calcification, is one of the common causes of hearing loss. In otosclerosis, the wall where the stirrup is adjacent to the inner ear becomes stiff as a result of irregular bone development and movement restriction occurs in the stirrup. As a result, sound waves cannot be transmitted to the inner ear fluids sufficiently and conductive hearing loss occurs. In this case, the inner ear is intact. only sounds cannot be transmitted. However, in the later stages of the disease, this structural defect can also affect the inner ear wall and sensorineural hearing loss may also occur.

Otosclerosis can be an inherited disease. Studies show that young-middle-aged women are more at risk. In addition, it is suggested that the disease is also associated with pregnancy-related hormone changes. In addition to hearing loss, patients may also experience tinnitus, dizziness and balance problems.

Tympanoplasty (Eardrum Repair and Middle ear bone chain repair)

“Tympanoplasty” surgery, which is applied in tympanic membrane perforations and chronic middle ear diseases, is technically the repair of the eardrum and the auditory system in the middle ear, as well as the removal of inflammation in the middle ear and the mastoid bone behind the ear.

Depending on the extent of the existing disease, the operation can be performed as only repairing the hole in the eardrum (myringoplasty), repairing the ossicular system that provides sound transmission in the middle ear with membrane repair (tympanoplasty), clearing the inflammation that has progressed into the mastoid bone (mastoidectomy) or a combination of these surgeries (tympanomastoidectomy).

When is Tympanoplasty Surgery Performed?

In patients who have a hole in the eardrum but do not have a significant hearing loss and there is no discharge unless water escapes into the ear, the surgery to be performed to close this hole is generally aimed at increasing the patient’s quality of life and preventing the progression of hearing loss over time by eliminating the need to protect the ear from water during bathing and swimming. It is done according to the patient’s preference.

Although the patient’s ear is protected from water and there is no inflammatory focus in the nose and sinus area that will cause ear discharge, if recurrent ear discharges are observed, the hole in the membrane should be closed in order to improve the quality of life and to prevent the progression of hearing loss or serious problems related to inflammation. In these patients, during the same surgery, both the hole in the membrane is closed and the problems in the small middle ear ossicles that transmit sound are intervened.

If an inflamed tissue called cholesteatoma is detected in the middle ear and mastoid bone, which progresses by dissolving the bone, this inflammation should be removed with surgery as soon as possible. In patients with cholesteatoma, the protection or repair of the hearing system is the second priority, and the main purpose is to clear the inflammation before it causes facial paralysis, inner ear-related hearing loss or intracranial complications (meningitis, brain abscess, etc.).

Surgery Technique

While deciding on the technique of the surgery, the condition of the disease, the location of the hole on the membrane, the structure of the ear canal, whether to intervene in the mastoid bone behind the ear during the operation, the preferences of the surgeon and finally the patient are effective.

Although very different surgical techniques are applied under the microscope in the middle ear and mastoid bone during the surgery, questions are frequently asked about this subject, since the patient and their relatives can see the surgery only by the incision in the skin.

Tympanoplasty surgery can be performed through incisions made through the ear canal, inside the ear or behind the ear. While surgery can be performed through the ear canal without an additional incision to repair only a small hole in the membrane, the approach applied by making an incision behind the ear is preferred in the holes in the middle and back of the membrane, through the ear, in the holes in the anterior part of the membrane and in cases where intervention is required to the mastoid bone. The main deciding factor in this regard is the preference of the surgeon who will perform the surgery.

The most commonly used tissue for the repair of the eardrum is the temporal muscle sheath. Since this tissue is close to the surgical site, it can be easily obtained during surgery. The cartilage membrane in front of the ear canal or ready-made materials (such as materials such as sterile meninges pieces that have undergone appropriate procedures) can also be used. In recent years, repair (cartilage tympanoplasty) using thin cartilage strips obtained from the cartilage in front of the ear canal, especially in large holes, has started to be preferred more and more due to both the ease of application and the success of the results.

When a repair is required to ensure the transmission of sound due to damage to the auditory ossicles, prostheses made of various materials, parts obtained from the cartilage in front of the ear canal, many different materials such as the middle ear ossicles themselves can be used by positioning and shaping.

Postoperative

Patients can usually be discharged from the hospital by dressing on the first day after surgery.

Special sponges in the external ear canal are cleaned at the end of 10-14 days in surgeries that do not involve intervention on the mastoid bone, and it is recommended that patients protect their ears from water and use ear drops containing antibiotics and cortisone in order to prevent infections and reactions in the operation area. Recovery in this group is completed in 3-4 weeks. In general, in the first month, it is necessary to be protected from flu infections and blows, and not to travel by plane. In these patients, the technical and functional success rate of the surgery is generally quite good, depending on the extent of the pathology and the preoperative hearing level.

On the other hand, in patients who have undergone intervention to the mastoid bone during the surgery, various dressings should be applied for varying durations depending on the type of surgery performed. Healing takes longer in this group, and the hearing gain in these patients is generally less than in the other group.

Especially if the cholesteatoma is located in the vicinity of the facial nerve and inner ear, the bone cannot be scraped in these areas in order not to damage the nerve and hearing, and disease may remain at the cellular level.

Since the risk of recurrence of cholesteatoma is high in these patients, follow-up examinations should be performed at regular intervals after surgery. In this group of patients, interventions for the restoration of the auditory conduction system can be performed when the cholesteatoma recurs in small foci or in the second-look control surgery to be performed 6-12 months later.

As a result, there is no standard approach for tympanoplasty surgeries that will suit every patient. In the selection of surgical techniques and applications to be used during the operation, especially in cases with cholesteatoma, the characteristics of the disease and the patient, the factors determined during the surgery and the surgeon’s experience are effective.