What are the management options for ear fullness after parotidectomy (parotid gland removal)?

Management of Ear Fullness After Parotidectomy

For patients experiencing ear fullness after parotidectomy, initial management should focus on ruling out otitis externa and tympanic membrane complications, followed by symptomatic treatment with reassurance, as this is typically a self-limiting condition related to surgical disruption of periauricular structures.

Evaluation of Post-Parotidectomy Ear Fullness

• Ear fullness following parotidectomy is a common postoperative phenomenon that requires systematic assessment to rule out complications versus expected post-surgical changes 1
• Evaluate the external auditory canal and tympanic membrane to rule out otitis externa, which may present with similar symptoms of fullness and discomfort 2
• Assess tympanic membrane integrity using otoscopy and consider tympanometry if the membrane is visible, as a normal Type A tracing would suggest intact tympanic membrane function 2
• Determine if symptoms are accompanied by other post-parotidectomy complications such as facial nerve dysfunction, hematoma, or salivary fistula 3

Management Options

First-Line Approaches

• Reassurance that ear fullness is often a normal post-parotidectomy sensation due to:

  • Surgical disruption of periauricular tissues 1
  • Possible sacrifice of the great auricular nerve, which can cause sensory changes in the ear region 4
  • Localized edema affecting the external auditory canal 3

• Conservative management:

  • Mild analgesics for associated discomfort 1
  • Patient education regarding the typically self-limiting nature of the symptom 1
  • Monitoring for 48-72 hours for improvement, as most post-surgical symptoms show significant decreases after the first day of appropriate management 2

Second-Line Approaches

• If ear fullness persists beyond 72 hours or worsens:
  • Reassessment of the ear to determine need for aural toilet or wicking if canal obstruction is present 2
  • Evaluation for possible seroma formation near the surgical site 3
  • Consider referral back to the treating surgeon if symptoms persist beyond 2 weeks 2, 1

Special Considerations

• Patients who underwent superficial parotidectomy with preservation of the posterior branch of the great auricular nerve may experience less sensory morbidity including ear fullness compared to those with complete nerve sacrifice 4
• Facial nerve preservation during parotidectomy is standard practice when a dissection plane can be created between the tumor and nerve, which may reduce postoperative complications including ear-related symptoms 2, 5
• For patients who had partial parotidectomy under local anesthesia, ear fullness may be less pronounced due to the minimally invasive nature of the procedure 6

When to Refer Back to Specialist

• Failure to improve after 2 weeks of conservative management 2
• Development of additional symptoms such as:
  • Facial weakness (suggesting facial nerve involvement) 5
  • Significant pain disproportionate to expected post-surgical course 1
  • Signs of infection including fever, purulent drainage, or increasing erythema 3
  • Hearing loss that was not present preoperatively 2

Prevention Strategies

• When possible, preservation of the posterior branch of the great auricular nerve during parotidectomy may reduce postoperative ear-related sensory symptoms 4
• Careful surgical technique with attention to preserving uninvolved structures during partial superficial parotidectomy for appropriate cases may minimize postoperative complications 5