Risks and Potential Complications of Surgery
THE EAR INSTITUTE OF TEXAS
It is not possible to list every complication that may occur before, during, and following a surgical procedure. The following discussion is included to indicate some of the risks and complications related to most ear surgeries. Consult your physician for those more common with your particular condition and procedure. However, all these operations are major and may have significant complications.
Occasionally a loss of hearing can occur: however, in the vast majority of cases hearing is the same and sometimes better. Often, total hearing loss will be indicated by your physician prior to surgery (this may vary depending on your specific operation). Fortunately, the development of hearing aids and devices, has allowed the transfer of sound from the operated ear to the other ear, so that one may hear for social or business purposes from the operated side.
Ear noise (tinnitus) usually remains the same after surgery as it did before surgery. In approximately 30% of patients the tinnitus may be less, but in 10% it may be more noticeable.
Taste Disturbance and Mouth Dryness
In approximately 5% of the patients, this disturbance may be prolonged. But in most it lasts for a few weeks and then disappears.
Dizziness and Balance Disturbance
In many of these patients, there is an improvement from the preoperative unsteadiness after surgery. Nevertheless, in most patients there is some temporary dizziness following surgery, which may be severe for days to a few weeks. Imbalance or unsteadiness on head motion is prolonged in 30% of the patients. Some patients notice unsteadiness when fatigued for several years. There are programs to enable the patient to overcome the dizziness and imbalance. In a few cases, the blood supply to the portion of the brain responsible for coordination (the cerebellum or brainstem) is decreased by the tumor or removal of the tumor. Difficulty in coordination and balance may, therefore, last in these patients for years.
This nerve controls the movement of the muscles to the face, including those that close the eye. It is very common to have a temporary paralysis of the muscles of the face following some procedures. This weakness may persist for six to twelve months and occasionally, there may be permanent residual weakness or paralysis.
A facial paralysis may result from nerve swelling, or nerve damage. If it is merely nerve swelling, it may return in a short time (three weeks to three months). Swelling of the nerve is common due to the fact that the nerve is compressed and distorted by the tumor in the internal auditory canal. Tumor removal with the use of the operating microscope, facial nerve monitor, and electrified instruments usually results in preservation of the nerve, but nerve stretching may result in swelling of the nerve, with subsequent temporary paralysis. Facial function is observed for approximately one year following surgery. If it becomes certain the facial function will not recover (approximately 15% of the cases), a second operation may be performed to connect the facial nerve to a nerve in the neck (facial-hypoglossal anastomosis).
The major medical problem with facial paralysis following this surgery is that the eye may become dry and unprotected. It can then become infected or abraded. Care by an eye specialist (ophthalmologist) may be necessary. It may be necessary to use ophthalmic (eye) drops, or apply ointment to the eye frequently, insert a gold weight beneath skin in the upper eye lid to close the eye lids, or even to partially sew the eyelids closed. The purpose of these efforts is to keep the eye moistened, as well as provide comfort, and improve the appearance.
Usually careful dissection and attention to details under the microscope will avoid complications. However, the blood supply to the vital brain centers may be disturbed in the removal of the tumor and some other procedure. If this occurs, serious complications result, including loss of muscle control, stroke, paralysis, or death. In our experience, death occurs rarely, even in the largest and most complicated cases.
Postoperative Spinal Fluid Leak
In surgery, there is a risk of a temporary leak of cerebrospinal fluid (fluid surrounding the brain). This leak is closed prior to completion of surgery, usually with fat from the abdomen. However, approximately 3% to 5% of the time this leak reopens and further surgery may be necessary to close it. Most of the time, this leak can be closed by placing a drain in the cerebrospinal fluid space through the back. While this drain is in place the patient has to remain in bed, and in the vast majority of cases this stops the leak without further surgery.
Postoperative infection occurs in approximately 3% of the patients. In a very small percentage of cases, an infection may involve only the external portion of the wound. When these complications occur, hospitalization is prolonged, and treatment with high doses of intravenous antibiotics is indicated. Occasionally, these antibiotics may cause an allergic reaction, suppress the body’s blood forming tissues, or may produce hearing loss in the good ear. Fortunately, antibiotic complications are rare.
Rarely, it is necessary to administer a blood transfusion during surgery. Adverse reactions to transfusions are rare. An occasional late complication is a viral infection of the liver (hepatitis). An even more rare complication is AIDS. Recent innovations in blood banking, however, have made this an extremely rare complication.