Otologic surgery encompasses a wide variety of surgical procedures with the main goals being elimination of chronic or acute ear infections and/or restoration of hearing. The various types of otologic procedures can best be divided based on the anatomic location of the disease or impairment. Working from lateral to medial, the external auditory canal (EAC) is the first landmark which can be subject to injury; this is followed by the tympanic membrane, then the middle ear space, and finally the inner ear.

1. External Auditory Canal – EAC stenosis is an infrequent but challenging problem often found as a result of previous surgery or as an idiopathic phenomenon in the immunocompromised patient. A stenotic canal prevents adequate evaluation of the tympanic membrane; cerumen impacted deep to the stenosis often creates hearing impairment as well. A canaloplasty, which involves remodeling the EAC to widen its lumen, is the surgery of choice for this problem.

2. Tympanic membrane – Perforation of the tympanic membrane is a relatively common finding and can often be dealt with asymptomatically for decades in certain patients. However, a majority of patients will suffer either persistent ear drainage or hearing loss as a result of a perforation. Subsequently, a tympanoplasty can be performed. A tympanoplasty uses autologous tissue, either temporalis fascia or perichondrium, as a graft to replace the injured tympanic membrane.

3. Middle ear space – A cholesteatoma is a benign but destructive and expanding growth of keratinizing squamous epithelium, which can fill the middle ear space and cause hearing loss and ear drainage. While this is the most common mass found in the middle ear, other etiologies such as a glomus tumor or even malignant carcinomas can be identified here. A mastoidectomy is the surgery of choice for removal of these tumors, especially if they extend into the mastoid bone. A canal-wall up mastoidectomy keeps the EAC intact and allows the mastoid to drain through the middle ear in the usual fashion, while a canal-wall down mastoidectomy (used for more severe disease) exteriorizes the mastoid cavity through an enlarged EAC.

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