Logo for University of Iowa Health Care This logo represents the University of Iowa Health Care
Meet the Iowa Otolaryngology Research Scholar FellowClick Here

Otology Service

last modified on: Fri, 12/29/2023 - 14:02

Rounds

  • Mastoid dressings
    • Gantz – change every day. 
    • Hansen - change every other day.
    • Dressing supplies include: adaptec, bacitracin, kerlix lite rolls, kerlix fluffs (10), scissors, +/- elastoplast. Have the mastoid dressings removed prior to rounds.
  • Check FN function, nystagmus, and incision site daily.

Clinic

  • Med students are NOT allowed to clean ears
  • In Gantz clinic, med students should staff with resident first so that resident can examine and fill out the physical exam portion.
  • Basic ear H&P: otalgia, otorrhea, hearing loss, vertigo, tinnitius, prior ear surgeries, family hx
  • General Pre-op:
    • ALL ear cases need audio w/in 3 months of surgery:
    • All translabs, mega skullbase, and Marlan’s MCFs should include abdominal fat graft on consent; Ask if need possible placement of lumbar drain in consent. Also risk of stroke, embolism, death, facial paralysis, taste dysfunction, inbalance, deafness, CSF leak, meningitis.
  • EAC dermatitis (itchy ears)
    • Gantz – Synalar 0.25% cream tid in 15g tube or 0.01% solution tid in 20ml bottle
    • Hansen – Valisone 0.1% ointment qday to bid

General considerations

  • All big otology cases should get full lab panel including coags and medicine clearance if deemed necessary
  • Document facial nerve function, Weber, Rinne, audiogram within 6 months
  • General otology/neurotology antibiotics (unless specified below)
    • Perioperative
      • Adults and children - Cefazolin IV and Decadron before incision.
      • Penicillin allergic - Clindamycin IV and Decadron before incision.
    • Postoperative
      • All other otology procedures aside from CWR, CI and BAHA – No postop oral antibiotics – (this includes skull base procedures).
      • Transcanal procedures - antibiotic drops (MH-fluoroquinolone, BG-cortisporin) BID until follow-up appointment with attending at one month.
      • Bacitracin to endaural and postauricular incisions BID starting after dressing removal.
    • OR prep: Tape up pre-op audio. No paralysis. Position patient on bed closer to operative side, head on Reston, bump under head if necessary to keep from rolling, tube taped off opposite. Turn 180deg, strap and test roll.

Case specific pearls

Middle ear cases

  • if done under local, use Phenergan, Demerol, and Versed IV for sedation.

Cochlear implants

  • most patients will stay for 23 hr obs (usually in CRC). They may take their mastoid dressing off on POD #2. They should go home w/ Abx. Will return to AUDIOLOGY in 1 month for hookup, not our clinic.
  • Keflex / clindamycin PO 1 week post-op

BAHA

  • usually outpatient. Keflex/clindamycin x 1 week post-op
  • BAHA’s follow-up in one week in MH clinic for healing cap removal.

Stapedectomy/stapedotomy

  • most patients will go home same day (Marlan) or stay for 23 hr obs (Gantz). For Gantz patients he wants them to lie flat for 6 hrs after surgery. 
  • Always do Weber test to ensure that they lateralize to operated ear.
  • Stapes and any cases with inner ear fistula get fluoroquinolone drops BID starting morning after surgery until follow-up appointment with attending at one month. Home care instructions: dry ear, nose blowing precautions, avoid flying. Should come immediately to the hospital if they are having vertigo or hearing loss! If so, needs to be seen immediately and checked with audiogram and nystagmus. No postop oral antibiotics.
  • F/u in 1 month for ear cleaning, f/u 4 months for audiogram

Tymp-mastoid

  • f/u 7 days for suture and packing removal, then use gtts until f/u at 1 month. RTC for bowl cleanings q6mo

Canal Wall Reconstruction Tympanomastoidectomy

  • Gantz admits for 48 hours of IV antibiotics, D/C Penrose drain POD #2, and home on Levaquin. Marlan will usually D/C day of surgery, home on Levaquin.
  • Adults - Zosyn and Cipro 750 bid IV before incision and for 48 hours postoperatively. Discharge on Cipro PO X 2 wk.
  • Children - Zosyn IV before incision and for 48 hours postoperatively. Discharge on Augmentin PO X 2 wk.
  • Penicillin allergic adults - Clindamycin and Cipro IV before incision and for 48 hours postoperatively. Discharge on Levaquin PO X 2wk.
  • Penicillin allergic children - Clindamycin IV before incision and for 48 hours postoperatively. Discharge on Clindamycin PO X 2wk.
  • Antibiotic drops (MH-Ciprodex, BG-Cortisporin) used BID starting after packing/suture removal at one week in ROD clinic and continuing until follow-up visit with attending at one month.
  • Bacitracin to incision BID starting after dressing removed.

Endaural and Canal Wall Down procedures

  • packing/suture removal in ROD clinic at one week then antibiotic drops (MH-fluoroquinolone, BG-cortisporin) BID until follow-up appointment with attending at one month

Acoustic Neuromas

  • Make sure pt has preop ABR and we have preop films.
  • Call SICU in AM to check they are expecting the patient.
  • Advise anesthesia to run the patient dry and have in the room mannitol 0.25-0.5 g/kg.
  • Need NIMS; no paralysis for ANY ear case (all general cases use NIMS), and Foley
  • MCF
    • Gantz - also need to order 4-view Stenver skull film. Will use temporalis fascia
    • Hansen – no Stenvers. Consent for abdominal fat graft. Use ResorbX plating system. Preop: 3 days of valcyclovir.
    • Patients will stay in SICU overnight for NSG monitoring. Some may have LD placed which will be managed by NSG. On POD #1 rounds be sure to be prepared with transfer orders (can use admit acoustic neuroma 3JPW orders) in hand. We have an agreement that if the patients are stable we will have transfer orders prepared by rounds. Home on POD #3-5 if leak test is negative, ambulating well, taking PO, no sign of meningitis. Dressings for Gantz to stay on 5 days, Hansen to stay on 4 days. F/U in 7-10 days for suture removal unless their PMD will remove for them.

Skull base procedures

  • need ophtho, NSG consults
  • Consent for possible abdominal fat graft
  • Periop abx - Vancomycin 1gm q 12, Flagyl 500mg q 6, Ceftax 2gm q 8 (from* Kraus*, Standardized regimen of abx in skull base surgery)