Myringotomy and tympanostomy tube insertion
PREOPERATIVE DIAGNOSIS: Chronic left otitis media and right serous otitis media.
POSTOPERATIVE DIAGNOSIS: Chronic left otitis media and right serous otitis media.
OPERATIVE PROCEDURE: Right myringotomy and tympanostomy tube insertion. Left mastoidectomy.
DESCRIPTION OF PROCEDURE: The patient was placed in the supine position under satisfactory general endotracheal anesthesia. The right ear was examined with the operating microscope. Anterior and inferior myringotomy revealed thick middle ear secretions that were removed by suction. Donaldson tympanostomy tube was inserted and Cortisporin drops were instilled.
The left ear was then placed in the jeweler?s headrest, prepped and draped. Lidocaine and adrenaline was used to infiltrate the skin behind the ear. A postauricular incision was made through the skin and subcutaneous tissue. The ear canal was examined. Cerumen was removed. The tympanic membrane appeared to be dull, but there was no evidence of active infection in the ear canal.
The postauricular incision was made through the skin, subcutaneous tissue, and mastoid periosteum. The periosteum was elevated anteriorly to expose the spine of Henle and the external auditory canal, and then posteriorly to expose the mastoid cortex. The mastoid cortex was removed with the cutting bur. Inspissated, pale, granulation tissue was encountered filling all mastoid air cells. This was sent for histologic study. This was removed with a curette. Further mastoidectomy was accomplished, exposing the sinodural angle and eventually the middle ear space, which was filled with granulation tissue which was removed with the curette as well. The middle ear space was not further entered, since it could not be adequately visualized.
Hemostasis was obtained along the walls of the mastoid cavity using the diamond bur. After it had been polished, the mastoid periosteum was closed with interrupted Monocryl. The postauricular incision was closed with interrupted Monocryl and running nylon. A mastoid pressure dressing was applied and the patient left the operating room in satisfactory condition.