Special Surgical Procedures II
LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery
Section II: EAR SURGERY
1-20
1-20. PREP FOR EAR SURGERY
a. For operations involving the ear, preparation normally consists of washing the outer ear and surrounding skin with an anti-bacterial detergent and irrigating the canal with a mild antiseptic solution. The canal may also be cleaned with cotton applicators. The hair should be shampooed.
b. Depending upon the approach in surgery and local policy, a 2-inch strip may be shaved at an area of incision. This would also be true in mastoid operations. If hair is to be shaved from the patient's head, the specialist should check local policy regarding the disposition of the hair.
c. Positioning and draping.
(1) Quietness and immobility of the patient are most important in otological (ear) surgery. The head must be carefully immobilized by whatever method is prescribed for a particular procedure. The patient is to be placed on his back with his head turned to the side, with the affected ear up. Great care must be taken in alignment of the patient, especially if the procedure is time consuming.
(2) In the presence of infection, disposable sheets and towels should be used. An opening can be readily made with scissors in the sterile sheet or towel to expose the operative site. A standard ear pack is used.
(3) Three towels are folded lengthwise and placed around the operative site. The first one is placed horizontally above the ear, the second towel is placed diagonally on the outer prepared skin area surrounding the ear, and the third vertically in front of the meatus. A folded fenestrated sheet is unfolded over the patient and table, with the operative site in view through the opening.
(4) The draped tables with sterile instruments and the operating microscope are positioned around the patient. For example, if the operation involves the left ear, the sterile instrument table is placed near the left side of the operating table. The scrub usually sits or stands near the instrument table and passes the instruments to the surgeon in such a manner that he does not have to turn away from the operative microscope.
(5) All safeguards should be taken to prevent explosive hazards. This is most important because there are many electrical appliances in use during otological surgery.
d. Anesthesia for ear surgery may be local or general depending upon the severity of the surgery to be performed and the age of the patient.
e. The dressing applied following surgery is usually one of two types. For internal canal work, an ear wick may be inserted. For surgery on the mastoid sinuses or any posterior approach, a large compression type dressing commonly referred to as a mastoid dressing is applied.
