Postoperative Course Prognosis

The mastoid dressing is removed by the patient on the first postoperative day. The patient is placed on prophylactic antibiotics for 5 days. Strict water precautions are observed using a cotton ball saturated with petroleum jelly or bacitracin ointment in

Skin grail pauem

Xeroform

Xeroform

Ear Canaloplasty
FIGURE 23-7 (A) Thin split-thickness skin graft with notch for bend at anterior sulcus. (B) Skin graft covering tympanic membrane and ear canal.

the meatus until the ear canal is healed sufficiently. The Xeroform and Silastic packing are removed at the first postoperative visit 3 weeks postoperatively. After packing removal, antibiotic-steroid otic drops are prescribed twice daily for 10 days. The second postoperative visit is at 5 weeks. If the canal is well healed and there is no evidence of infection, the drops are discontinued and the patient is seen several weeks later. If edema, granulation tissue, or infection is present, the drops are continued for an additional 7 days and the patient is seen in another 2 weeks. The patient is seen every 2 weeks until the ear canal is healed properly. Granulation tissue in the canal should be cauterized with silver nitrate or trichloroacetic acid. Cauterization shrinks the granulation tissue and promotes epithelializa-tion.

Patients younger than 18 years old who have undergone canaloplasty for exostoses should limit cold-water exposure. Further exposure to cold water in this age group may increase the risk of exostosis recurrence.

Patients who require skin grafting are predisposed to infection and accumulation of debris. Skin grafts do not contain the normal apocrine and sebaceous glands, which normally cleanse and protect the ear canal from infection. In addition, patients with soft tissue stenosis may be prone to postoperative infection because of their previous history of chronic otitis externa. Therefore, patients undergoing canaloplasty for acquired stenosis should be examined at least every 6 months for the first 2 years after the ear canal is healed.

Hearing results after surgical treatment of bony stenosis are often excellent. Hearing results after repair of soft tissue stenosis are also good with air-bone gap closure to within 20 dB in 61 to 94% of

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