Aural Atresia Repair: Postoperative Instructions

Operative Procedure

Surgical repair of aural atresia involves creating a new ear canal and eardrum. When indicated, the ossicles (little bones of hearing) are modified to allow the transmission of sound energy to the inner ear. A skin graft is used to line the new ear canal. The skin graft of the ear canal is stented for 7-10 days with a pack of fine gauze strips saturated with antibiotic ointment. Patients are usually discharged one to two days following surgery.

Postoperative Care

You will be discharged with an oral antibiotic to take for ten days following surgery.

• Please fill the prescription promptly and take all of the medicine as directed until the entire supply is gone.
• Analgesics beyond Tylenol are usually not required.
• Please do not use aspirin containing products for ten days after surgery.

The ear canal packing will drain for several days following surgery. You will be given cotton balls, which can be placed on the outer ear to absorb this ear canal drainage. The cotton can be changed as needed (i.e., when it gets dirty).

The incision behind the ear is to be cleaned gently with soap and water forty-eight hours after surgery. You may use diluted Hydrogen Peroxide and water (one to one ratio) if there is a crust, which is not easily removed with soap and water. Any time you are going to clean your ear, please wash your hands thoroughly prior to starting.
Two days after surgery you may shampoo your hair and wash your scalp. Before then, use a shower cap, when bathing/showering.Gently pat dry the incision. Please keep the ear dry by protecting it with a cotton ball covered with Vaseline or petroleum ointment only when bathing or showering.

The skin graft donor site (buttock, abdomen or arm) is usually covered with a plastic adhesive bandage (Duraderm). As long as the donor site is covered with this plastic bandage, there should be no pain from this area. Pain occurs when the donor site is exposed to air before new skin grows back (usually 10 to 14 days). It is normal for blood-tinged fluid from the “weeping” donor site to accumulate under this bandage, especially in the first few days after surgery. This fluid is usually aspirated through the plastic bandage before discharge from the hospital. The hole in the plastic cover can be covered with another plastic cover/bandaid.

The Duraderm bandage cover may be undermined or displaced by the fluids from the donor site to the point where it needs to be replaced. You will be given an extra Duraderm bandage for this possibility. The Duraderm plastic cover can be kept clean with soap and water.

The Duraderm comes off ten days or later following surgery, it need not be replaced. By this time, the new skin will have regenerated to protect the donor site. The donor site, nevertheless, will be red and look “raw” but it should not be painful to the touch.

FIRST POSTOPERATIVE VISIT

The first postoperative visit occurs ten days after surgery for removal of sutures and the ear canal pack. The ear canal will be cleansed with an antibiotic steroid solution.

Thereafter, you will be instructed not to allow water in the ear canal until told to do so. Please keep the ear dry by protecting it with a cotton ball covered with Vaseline or petroleum ointment only when bathing or showering.

SECOND POSTOPERATIVE VISIT

The second postoperative visit occurs one month after surgery. At this time, the superficial layer of the skin graft will have sloughed off leaving a new layer of fresh skin lining the ear canal. The sloughed graft will be removed during this visit and any raw areas of the ear canal will be treated with topical medication if indicated.

Frequently, a subsequent follow-up visit with me or with your local referring otolaryngologist may be recommended until final wound healing occurs – usually within eight to twelve weeks after surgery.

In certain cases, where there is narrowing of the newly operated ear canal, a contoured silastic stent is utilized to keep the ear canal patent until final healing occurs over six to 12 months. The stent is hollow so sound can travel to the recreated ear drum for hearing.

HEARING

The hearing will be improved within two months after surgery. Frequently, it continues to improve over the following ten to twelve months after surgery as healing continues. A second audiogram should be obtained one year after surgery.

LONG-TERM CARE

Since the grafted skin in the reconstructed ear canal does not contain wax-secreting glands only found in a normal ear canal skin, it is imperative that the ear canal be cleaned of the sloughed skin layer normally shed by the skin. This usually needs to be cleaned every six to twelve months under a microscope by an otolaryngologist. This is a lifelong commitment. Patients have noted improvement in their hearing after removal of the sloughed skin layer. As children get older, they frequently notice a slight decrease in hearing with the dead skin accumulation. In turn, they are able to inform their parents when the ear needs to be cleaned. Nevertheless, this usually occurs about every six to twelve months.

Please call if these instructions are not clear, if there are any further questions or if we may be of further help. If there is ear drainage, ear pain, dizziness facial weakness or another issue of concern, please contact us.