A 28-year-old woman with a history of chronic conductive hearing loss presents for right tympanomastoidectomy.
Why is tympanomastoidectomy performed?
When the eustachian tube malfunctions, a vacuum is created in the middle ear. This vacuum is usually associated with chronic upper respiratory infections and allergies. The vacuum causes suction on the tympanic membrane that is already weakened by recurrent infections. The result can be cholesteatoma, which is an abnormal growth of primarily skin cells that occurs behind a perforated tympanic membrane. Damage to nearby bone surrounding the ear is a likely consequence of cholesteatoma. Associated symptoms include progressive hearing loss, dizziness, facial nerve damage, and central nervous system infections with extension into the brain. Tympanomastoidectomy is performed to remove cholesteatoma and infected bone from the middle ear.
Surgical treatment consists of an incision made behind the ear, opening the mastoid and exposing the middle ear. Cholesteatoma or infected tissues or both are removed. The tympanic membrane is patched, and packing is placed in the external auditory canal.
What the preoperative anesthesia considerations are associated with tympanomastoidectomy?
Anesthesia assessment before tympanomastoidectomy does not differ much from basic anesthesia assessment. Issues specific to middle ear disease should be addressed. Decreased hearing acuity or use of hearing aids can make communication challenging. Common manifestations of middle ear–related disorders include nystagmus, vertigo, nausea, and vomiting. A history of motion sickness or postoperative nausea and vomiting (PONV) is an important issue to consider in the anesthetic plan.