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Endoscopic Transcanal Cholesterol Granuloma Surgery | London & Essex

  Endoscopic Transcanal Cholesterol Granuloma Surgery: Advanced Minimally Invasive Ear Care A persistent feeling of fullness in one ear, fluctuating hearing loss, or a deep, dull earache can easily be mistaken for a standard Eustachian tube dysfunction or stubborn middle ear fluid. However, when these symptoms persist despite routine medical treatment, a closer clinical examination may reveal a dark, bluish discolouration glowing behind the eardrum. In many cases, this distinct visual sign points to a Cholesterol Granuloma —an inflammatory, fluid-filled cystic lesion packed with cholesterol crystals. While hearing the term "granuloma" can cause immediate anxiety, these lesions are non-cancerous, benign formations. Historically, accessing and draining a cholesterol granuloma required large incisions behind the ear and extensive bone removal (a mastoidectomy). Today, modern surgical advancements allow skilled otologists to access and drain these lesions using minimally invasive...

Ear Surgery

Mr Gaurav Kumar      Consultant ENT surgeon
This information relates to ear surgery ie tympanoplasty (repair of ear drum), mastoid surgery, stapes surgery and ossiculoplasty.

What is mastoid bone?
Mastoid bone is like a honeycomb bone which can be felt behind the ear. It is connected to ear proper, so infection can spread to this bone. Cholesteatoma, is a kind of ear infection which can erode bone and cause complications of smelly ear discharge, hearing loss, rarely facial weakness or brain infection.

Why should I have ear surgery?
The main aim of ear surgery is to make the ear dry and safe, so that patient does not have any more infections and its complication. Other is to improve or preserve the hearing if possible.

How is an operation performed?
The operation is generally performed under a general anaesthetic but rarely can be performed under local anaesthetic. A cut on the skin may be made behind the ear or front of the ear. We will discuss with you before the procedure. Once the operation has been done skin is closed with tissue glue and all stiches inside are dissolvable. You may have a bandage on wound which you can remove after 24 hours.
You may go home same day or next day morning.

Post op care?
Keep the wound and ear dry for six weeks. The white cotton ball at the entrance of ear canal can get soaked with blood frequently for first 72hours which may need changing with a fresh one. Packing in the ear is removed after two to three weeks’ post op. No active physical activity should be undertaken for six weeks. You should keep your ear dry. Plug the ear with a cotton wool ball coated with Vaseline when you are having a shower or washing your hair.  Avoid straining/lifting anything heavy for the first few weeks after surgery.  Avoid air travel for two months. 
Always try to sneeze with open mouth and DO NOT TRY TO POP the ear.

What are the options for an ear infection?
Surgery is the only option to clear cholesteatoma infection. A perforated eardrum can be managed by regular ear cleaning.

What are the risks of having surgery?
As with every surgery, there are potential complications, though very rare. We have to discuss all possible complications with you so that you can make an informed decision.

There is a potential risk of hearing being worse after the procedure and a very rare risk of total hearing loss altogether. Depending on the type of operation there may be a chance of improving the hearing on the second stage.

Dizziness may occur after the procedure but rarely last after one week and gradually resolve.

Tinnitus may persist or appear after the procedure, which may be entirely unrelated to the operation performed.

Change in taste could appear after surgery due to stretching of taste nerve or sacrificing nerve if involved in infection to achieve dry ear. This may improve up to one year.

Numbness of the ear, this improves after a couple of months.

Facial weakness is a potential complication of ear surgery. We use nerve monitoring during the procedure. It can appear after a few days and can be temporary or permanent.

CSF is fluid around the brain. CSF leak can happen during the procedure due to infection eroding the bone or during drilling. If it happens we repair it and advice given. This can cause a risk of meningitis/ brain infection.


Follow up
All patients are followed up after 2-3 weeks after the procedure. If you need a sick certificate, please ask a nurse for it or your GP.

CONTACT ENT TEAM OR COME TO ACCIDENT EMERGENCY IF YOU
-    Have temperature
-    Headaches not responding to regular painkillers
-    Dizziness getting worse.

-    Facial weakness 

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