Postoperative Care

Typically, the packing material of Gelfoam and antibiotic ointment is completely suctioned from the external canal 1 to 2 weeks after the surgical procedure. Antibiotic steroid-containing drops are used for an additional 2 weeks to clear the ear of residual ointment and Gelfoam, the latter of which can lead to granulation and fibrous tissue formation if inadequately removed from the TM. The adult patient is instructed to begin the Valsalva maneuver, and children are instructed to use the Otovent

FIGURE 6-8 Series demonstrating sequence of palisade reconstruction (left ear). (A) Total ossicular replacement prosthesis (TORP) in place. (B) Initial cartilage placement. (C) Reconstruction of the scutum. (D) Reconstruction of remainder of posterior tympanic membrane.
FIGURE 6-9 Postoperative appearance of tympanic membrane after palisade reconstruction (right ear).

(Invotec International, Jacksonville, FL), three times a day beginning 2 to 3 weeks after the surgery. A postoperative audiogram is obtained 6 to 8 weeks later, and the TM is examined. If the hearing result is good and the TM is clear, the ear is examined at 6 months and again at 1 year from the date of surgery. If effusion is present, nasal steroids are added, the Valsalva (or Otovent) is encouraged, and the ear is examined at 3 months. If the effusion is still present at that time, the ear is intubated. If a total cartilage reconstruction had been performed, tube insertion using traditional techniques can be difficult. In this situation, a CO2 laser myringotomy is preferred, followed by insertion of a soft tube, such as the Goode T-tube (Medtronic Xomed Surgical Products Inc., Jacksonville, FL).

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