My daughter is 6 1/2 years old. She has suffered from chronic ear infections for 4 years. She also has a partial hearing loss in one ear. We have under gone several surgical procedures including tube placement on 5 different occasions, as well as an adenoidectomy and IV antibiotics. After one and a half years of antibiotic ear drops and vinegar and water irrigations her ENT doctor ordered a CT Scan. The scan revealed a blockage of the drainage tube which he thought was a cholesteatoma, but was unable to clarify that is what it was. He has now decided to do a mastoid surgery to see exactly what the blockage is. We are all very concerned about the procedure and what it entails. I also had a concern when the scheduling nurse mentioned a facial nerve specialist. I have a pre-op appointment in 6 weeks but these concerns are nagging me and I have had no luck receiving my answers from her surgeon. What exactly does he plan to do and why the nerve specialist? What is the expected outcome and the risks. How common is this surgery? And what can I do to prepare her? Please help.
Reply: ----------------------------------
Mastoid surgery is usually indicated in situations where there are signs and symptoms of chronic ear infection that persist despite sustained and comprehensive medical intervention such as that which you have described took place with your daughter and when there is radiographic (eg CT scan) evidence of disease. The intent of mastoid surgery in such instances is to remove the chronically infected tissue. The mastoid is complex system of air cells in the bone behind the ear which communicate with the middle ear space behind the ear drum. After leaving the brain, the facial nerve courses through the mastoid bone where it exits just below the ear and then courses through the face to innervate the muscles of facial expression (smile, frown, etc.) If the facial nerve is injured, facial paresis or paralysis can occur which can be temporary or permanent. The risk of injuring the facial nerve during mastoid surgery is quite low but can be minimized even further because of modern technological advances including high powered magnification, new advances in irrigating drills, and most importantly the availability of intra-operative continuous facial nerve monitoring electronically during surgery. I am unclear as to the reference to a "facial nerve specialist" - generally speaking, management of peripheral facial nerve problems is within the province of an ear, nose, and throat specialist.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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