INSTRUCTIONS AFTER EAR SURGERY

Dr. Neal M. Jackson, MD

Pediatric and Adult Neurotologist (Ear & Skull Base Surgeon)

YouTube Video Link: Instructions After Ear Surgery

During the Surgery

-       The patient will be “asleep” under general anesthesia during the surgery. This can lead to nausea and/or drowsiness after the surgery.

-       Once the patient is asleep, a breathing tube will be placed through the mouth for breathing while under anesthesia. This may cause a sore throat for a few days.

-       Next, a special device called a facial nerve monitor is set up.  This requires small electrode leads (needles) that are placed around the eyebrow and around the mouth.  The facial nerve monitor is used throughout the case to check the status of the facial nerve, which controls the muscles of facial movement and is potentially at risk with ear surgery. Patients may notice slight bruising or soreness in the area for a few days.

-       At the end of the surgery, a dressing is placed over the ear.  This plastic cup is filled with gauze bandages which keep the ear covered and collects any drainage from the ear canal (see below).  The Velcro headband is adjustable for your comfort. This does NOT need to be tight!  You can take this off the morning after surgery and re-use during sleep.  The gauze can be replaced if it gets soiled.  

^^^For Tympanoplasty, Mastoidectomy, Ossicular Chain Reconstruction, or Stapes surgery:^^^

During the Surgery

  • Your surgery included an incision inside the ear canal.  To help this wound heal, the ear canal is delicately “packed” (filled) at the end of the surgery with antibiotic ointment and small gelatin sponges soaked with antibiotics. It is VERY important that these stay in place as you heal. Leave the inside of the ear alone. Do NOT let water get inside your ear canal.

  • If an incision is made behind the ear, you will either have “skin glue” or small absorbable stitches which will dissolve in 2-3 weeks. There are many more stitches deeper inside the wound, but these are not visible once the skin is closed.  Keep this incision dry for 72 hours.

  • At the end of the surgery, a cup dressing is placed over the ear.  This plastic cup is filled with gauze bandages which keep the ear covered and absorb the bloody drainage from the ear canal (see below).  The Velcro headband is adjustable for your comfort and does not need to be tight.  You can take this off the morning after your surgery.  Many people prefer to sleep with this on for the first 1-2 weeks after surgery when the ear is still draining.

    Healing Inside the Ear Canal and Ear Drum 

    Your surgery required an incision in the ear canal.

    -       The ear canal has been packed with antibiotic ointment and absorbable packing sponges to help hold the skin and eardrum in place.

    -       Keep a dry, clean cotton ball in the outer part of the ear for the first week. Some of the ointment and packing may come out on its own.

    -       It is common to have some red, pink, yellow, orange drainage from the ear canal over the first few weeks, this should decrease in amount as you get further out from surgery. Once the drainage stops, the ear canal can be left open, without using any cotton.

    -       The ear canal must be kept dry until it fully heals. Whenever you wash your hair or shower, you need to use an earplug to keep water out. The best way for most patients to do this is to saturate a cotton ball with Vaseline, and place it in the outside bowl of your ear. This can be smoothed against the outer ear to create a watertight seal. Dry cotton will draw water into the ear, which is what should be avoided, so please be sure to use the cotton ball with Vaseline to prevent water in the ear. Continue to do this until specifically instructed by your surgeon to stop. It usually takes about 2 months for the ear canal to fully heal before water is allowed back into the ear.

    After the Surgery

  • KEEP THE EAR DRY.  If any water gets into the ear canal, it could disrupt and undo the delicate reconstruction.

    • When showering, do not let water hit the ear directly for least 2 months.  The delicate skin and ear drum are still healing.

    • When bathing, do not submerge your head in the water.

    • Options for washing your hair:

      • Wash your hair in the sink with the help of an assistant, while paying special attention to keeping the ear dry.

      • Use Dry Shampoo, which is a hair spray and keeps the ear dry.

    • Place a cotton ball with Vaseline ointment at the edge of the ear canal. 

    • Water is not sterile (perfectly clean by surgical standards) and can carry bacteria into the wound which could cause an infection.

  • LEAVE THE PACKING IN THE EAR CANAL.  At the end of the surgery, the ear canal is packed will small sponges soaked in medicine.  The packing sponges are precisely placed to hold the delicate tissues in place as they heal.  Please do NOT try to pick them out!  Occasionally one of the sponges will tumble out or accidentally come out if it is stuck to the cotton ball—that is OK.  Do not try to place the sponges back in the ear canal—just leave them out.

  • PLACE EAR DROPS IN THE EAR CANAL.  The ear drops are medicine for the ear. They help prevent infection as the wound heals.  After removing the soiled cotton ball, apply the ear drops to the packing in the ear canal. Then cover with a fresh cotton ball. If it seems that the drops do not go in very deep, that is OK. Still apply the drops.

  • EXPECT BLOODY DRAINAGE.  Some bloody drainage is normal after ear surgery.  This is almost never true bleeding from an open blood vessel.  Rather, the drainage is some bloody oozing from the wound edges, and the ear drop solution used to clean the ear during surgery.  The cotton ball is used to absorb the external drainage.  When the cotton ball gets saturated, replace it with a fresh clean cotton ball.

    • If the drainage is profuse or develops a foul odor, please call the office.

  • LIMITED ACTIVITY FOR TWO (2) WEEKS.  Avoid strenuous activity for at least 2 weeks.  Walking is great.  Anything more than walking can disrupt the delicate healing process.  This means no running/jogging, lifting weights, excessive bending over, gymnastics, yoga, yard work, cleaning the garage, swimming, etc., etc.  The ear reconstruction is very delicate, and therefore activities that cause head motion, sweating, or straining/grunting can disrupt the delicate reconstruction.  

  • DON'T BLOW YOUR NOSE for 2 WEEKS.  The ear and the back of the nose are connected by a natural tunnel called the Eustachian tube.  If you blow your nose, you will be sending high amounts of pressure to your ear which could damage the healing ear.

  • IF YOU WEAR GLASSES, REMOVE THE ARM ON THE OPERATED SIDE for 1 week.  Do this so the arm doesn't rest on the fresh wound as it is trying to heal. [note: this only applies if you had an incision behind the ear]

  • UNUSUAL SOUNDS AND SENSATIONS MAY OCCUR IN THE EAR AS IT HEALS.  As the ear heals, there may be a plugged sensation, popping/gurgling/liquid sounds, ringing, muffled hearing, etc.  The patient will often hear internal body sounds (swallowing, heartbeat, chewing, etc.) louder; this is common and should go away after the ear heals.

  • YOUR POST-OP CLINIC APPOINTMENT WILL BE IN 1-3 WEEKS.  At the first visit, much of the packing will be gently removed by Dr. Jackson or one of his associates.  Sometimes a small amount is left over the delicate ear drum as it heals.  

    Prescriptions for Medicines to take after surgery

    You SHOULD take:

    Ear drops – These are applied to the packing in the ear canal.  You will be prescribed either “CiproDex” (Ciprofloxacin/Dexamethasone) or “Floxin” (Ofloxacin).  The ear drops keep the ear clean and promote healing.

    Antibiotic pill- This is a pill to be taken by mouth for 5-7 days to minimize infection. You will be prescribed Keflex or Clindamycin.

    You CAN take:

    Pain Medicine- You should try over-the-counter Tylenol and ibuprofen first (read the instructions and be careful not to take too much). Gabapentin can be helpful as well for pain control.  Narcotic pain medicines (such as Norco) are avoided due to potential side effects including drowsiness, constipation, addictive potential, etc.

    Anti-nausea pill- If needed, you can take “Zofran” (ondansetron) for nausea.  Sometimes nausea is due to anesthesia drugs that haven't worn off yet or due to side effect of the other medicines.    

    _______________________________

    ^^^ For Cochlear Implant, Bone Anchored Hearing Aid (BAHA), Endolymphatic Sac Decompression Surgery,  Encephalocele Repair, or Skull Base Surgery:^^^

  • Your surgery did NOT include an incision in the ear canal so you do NOT need to  follow the above instructions about packing, ear drops, nose blowing, etc. 

  • KEEP THE INCISION DRY FOR 72 HOURS.  After 72 hours, it is OK for water to run over the incision in the shower, but do not soak it.

  • LIMITED ACTIVITY FOR TWO (2) WEEKS.  Avoid strenuous activity for at least 2 weeks.  Walking is great.  Anything more than walking can disrupt the delicate healing process.  This means no running/jogging, lifting weights, excessive bending over, gymnastics, yoga, yard work, cleaning the garage, swimming, etc., etc.  The ear reconstruction is very delicate, and therefore activities that cause head motion, sweating, or straining/grunting can disrupt the delicate reconstruction.  

  • IF YOU WEAR GLASSES, REMOVE THE ARM ON THE OPERATED SIDE for 1 week.  Do this so the arm doesn't rest on the fresh wound as it is trying to heal. [note: this only applies if you had an incision behind the ear]

  • UNUSUAL SOUNDS AND SENSATIONS MAY OCCUR IN THE EAR AS IT HEALS.  As the ear heals, there may be a plugged sensation, popping/gurgling/liquid sounds, ringing, muffled hearing, etc.  The patient will often hear internal body sounds (swallowing, heartbeat, chewing, etc.) louder; this is common and should go away after the ear heals.

  • YOUR POST-OP CLINIC APPOINTMENT WILL BE IN 1-3 WEEKS.  

    Prescriptions for Medicines to take after surgery

    You SHOULD take:

  • Antibiotic pill- This is a pill to be taken by mouth for 5-7 days to minimize infection. You will be prescribed Keflex or Clindamycin.

    You CAN take:

  • Pain Medicine- You should try over-the-counter Tylenol and ibuprofen first (read the instructions and be careful not to take too much). Gabapentin can be helpful as well for pain control.  Narcotic pain medicines (such as Norco) are avoided due to potential side effects including drowsiness, constipation, addictive potential, etc.

  • Anti-nausea pill- If needed, you can take “Zofran” (ondansetron) for nausea.  Sometimes nausea is due to anesthesia drugs that haven't worn off yet or due to side effect of the other medicines.    

    HEARING

    -       Because of swelling, fluid, and healing processes after surgery, hearing will usually be worse right after surgery.

    -       It often takes about 2 months for enough healing to take place for the hearing to begin improving.

    -       Often as healing occurs, there will be occasional sounds like crackling, popping, squeaking, echoing, and/or pulsing. This is pretty common and goes along with the healing process. Hearing may also fluctuate somewhat as air begins to return to the middle ear.

    If you have any questions, please call the office.  For adults, call 504- 988- 5561 for adult practice at East Jefferson.  For children, call 504-896-9832 for pediatric practice at Children's Hospital New Orleans.