An audit of 'dead ear' after ear surgery

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Introduction

'Dead ear' is a term used to describe profound sensorineural hearing loss with or without vertigo. When dead ear occurs after ear surgery, it is probably due to damage to delicate inner-ear structures as a result of mechanical manipulation, transmitted vibration or direct surgical disruption. Few complications of ear surgery are likely to cause more consternation. It is a problem said to occur following approximately 1 per cent of operations for otosclerosis, for cholesteatoma, and for chronic otitis media without cholesteatoma.

Dead ear is routinely mentioned in the consent process for middle-ear operations.

The dead ear may be predictable or come as a surprise. The despair felt by the patient and the surgeon after such an event is ironic, since one of the initial indications for the operation is to prevent the ear pathology from causing precisely this problem.

The low incidence of post-operative dead ear means that individual surgeons, especially general otolaryngologists treating only a small number of cholesteatoma cases, may be fortunate enough never to encounter this complication. However, few experienced surgeons will have encountered no cases of dead ear.

This report presents an audit of dead ear in a series of cholesteatoma cases from two hospitals in the county of Norfolk, UK.

Method

In order to identify patients who had developed dead ear post-operatively, the author scrutinised records compiled as part of the International Otology Audit (see http://www.ear-audit.net).¹These records represented all otology patients operated upon under the care of the author at James Paget University Hospital and the Norfolk and Norwich University Hospital, Norfolk, between 2006 to 2012.

The International Otology Audit is a prospective, web-based audit of otology procedures which collects information about the nature and extent of disease and the operations performed. The audit also gathers prospective data about the post-operative course of the patient in the months and years after the procedure. It is free to use and is supported by ENT UK, the professional association of British ENT surgeons.

Analysis of the case records considered the following questions: (1) what was the incidence of dead ear in relation to the procedures performed?; (2) was the cause of the dead ear apparent, and if so was it predictable...