The primary goal of surgery for chronic otitis media and cholesteatoma is to remove all infection and cholesteatoma. Hopefully, this will stop the ear from draining. It will prevent more problems later. A good result can be expected in 80 to 90 percent of the cases. In many cases, a second surgery is needed to look for recurrence of the disease. This surgery is usually performed six to 18 months after the first surgery.
The secondary goal is to make hearing better. Failure to improve hearing is not a complication. Success depends almost as much on the ability of the body to heal and preserve the reconstruction as on the surgeon’s skill. Fortunately, even those cases that fail may often be revised.
Sometimes, a canal-wall-down mastoidectomy is required to treat the disease. This will involve enlarging the opening to the ear canal and converting the normal “tube-shaped” ear canal into a mastoid “bowl.” This will require lifelong visits for cleaning by the ENT physician, roughly every six to 12 months. One benefit of this surgical approach, if necessary, is that it is uncommon for the ear disease to come back.
The success rate of ossicular chain reconstruction to improve hearing depends on the problem. If the stapes is intact, the rate of a good hearing result is about 75 percent. If the stapes is not intact, the rate of a good hearing result is about 50 percent.
Although the surgeon always tries to repair the problem, the healing process has a major impact on the ultimate hearing outcome. Scar tissue can pull on the delicate ossicles and/or ossicular prosthesis, moving them from the best position. If the hearing result is less than expected, surgery can often be done again to try to make it better.