Name of the Procedure:

Tympanic Neurectomy
Common name(s): Intratemporal neurectomy, Tympanic nerve section
Technical term: Tympanic neurectomy

Summary

Tympanic neurectomy is a surgical procedure where the tympanic nerve, a branch of the glossopharyngeal nerve, is cut. This is usually done to alleviate certain chronic ear pain or discomfort by disrupting the nerve signals that transmit pain from the ear to the brain.

Purpose

The procedure primarily addresses:

• Chronic otalgia (ear pain) that has not responded to other treatments.

The goal is to alleviate the persistent ear pain and improve the patient's quality of life.

Indications

• Persistent, severe otalgia unresponsive to medical management.

• Diagnosed causes of neuralgia involving the tympanic nerve.

  Patient criteria:

• Detailed history of chronic ear pain.
• Failed conservative treatments.
• Comprehensive otolaryngological assessment showing nerve involvement.

Preparation

• Fasting for at least 6-8 hours before the procedure if under general anesthesia.
• Discontinuation or adjustment of certain medications as advised by the doctor.
• Preoperative blood tests and possibly imaging studies (like MRI or CT scan).
• Preoperative consultation with the surgical team and anesthesiologist.

Procedure Description

1. The patient is positioned, and anesthesia (local or general) is administered.
2. An incision is made to access the middle ear.
3. The surgeon identifies and isolates the tympanic nerve.
4. The nerve is cut to halt the pain signal transmission.
5. The incision is closed with sutures.

Tools/Equipment: Surgical microscope, micro-instruments for nerve cutting.

Anesthesia: Local or general, depending on the extent and complexity of the surgery.

Duration

The procedure typically takes about 1-2 hours.

Setting

This procedure is usually performed in a hospital or a specialized surgical center.

Personnel

• Otolaryngologist (ENT surgeon)
• Anesthesiologist
• Surgical nurses
• Potential support staff

Risks and Complications

Common risks:

• Infection
• Bleeding
• Temporary or permanent hearing loss

Rare risks:

• Facial nerve damage
• Persistent or worsened pain
• Balance disturbances

Complications are managed promptly with antibiotics, surgical corrections, or other interventions as needed.

Benefits

• Relief from chronic ear pain.
• Improved quality of life.
• Reduced need for pain medications. Benefits may be realized immediately or within a few days after surgery.

Recovery

• Post-operative care includes keeping the incision site clean and dry.
• Pain management with prescribed medications.
• Follow-up appointments to monitor healing and progress.
• Light activities can be resumed within a few days, but strenuous activities should be avoided for several weeks.
• Recovery typically spans a few weeks, although this can vary.

Alternatives

• Medications: Pain relievers, anti-inflammatory drugs.
• Nerve blocks or injections.
• Physical therapy and behavioral therapy.
• Pros of alternatives: Non-invasive, lower immediate risk.
• Cons of alternatives: May not be effective, need for long-term medication use.

Patient Experience

During the procedure, if under general anesthesia, the patient will be asleep and feel nothing. If under local anesthesia, they may feel some pressure but no pain. Post-procedure, there may be mild discomfort or pain at the incision site, which can be managed with prescribed pain medications. Patients will be encouraged to rest and follow specific post-surgical care instructions to ensure optimal recovery.