What are the post-operative care guidelines for external auditory canal contouring?

Post-Operative External Auditory Canal Care After Cancer Surgery

For post-operative external auditory canal (EAC) management after cancer surgery, maintain meticulous canal hygiene through gentle aural toilet under microscopic visualization, avoid water exposure, and consider silastic sheet stenting for 5-10 days to prevent stenosis while allowing drainage and inspection.

Immediate Post-Operative Canal Management

Stenting Protocol

• Place a rolled, tapered silastic sheet (RTSS) of 0.3mm thickness with antibiotic ointment applied to one surface at the completion of surgery to prevent canal stenosis while enabling transcanal drainage and visual inspection 1
• Remove the silastic stent at 5-10 days post-operatively, which allows for early visualization of the tympanic membrane and canal starting from post-operative day 1-3 1
• The silastic sheet method is superior to conventional packing as it permits immediate observation and treatment access while preventing adhesions 1

Aural Toilet Technique

• Perform gentle aural toilet using atraumatic cleaning with suction under microscopic guidance rather than irrigation, particularly given the post-surgical state 2
• Use body-temperature saline solution or hydrogen peroxide if gentle lavage is necessary 2, 3
• Avoid aggressive irrigation with tap water, as this has been implicated in necrotizing otitis externa, especially in immunocompromised patients (which cancer patients often are) 2

Critical Safety Considerations

High-Risk Patient Factors

• Cancer patients are often immunocompromised from chemotherapy or radiation, placing them at higher risk for post-procedure otitis externa 2
• If the patient has received head and neck radiation, the EAC undergoes epithelial thinning and atrophy of ceruminous glands, making the tissue extremely fragile and prone to osteoradionecrosis 2
• Use only atraumatic suctioning under microscopic guidance in radiated or immunocompromised patients 2

Avoiding Iatrogenic Complications

• Never use ear candles, as they cause harm including canal obstruction, hearing loss, and tympanic membrane perforation 2, 3
• Minimize trauma during any cleaning procedure, as injury to radiated ear canals may be slow to heal or lead to osteoradionecrosis 2
• Consider acidifying ear drops post-procedure in immunocompromised patients to reduce infection risk 2

Ongoing Surveillance

Clinical Monitoring

• Provide close follow-up for immunocompromised or radiated patients 2
• Monitor for signs of infection, stenosis, or cholesteatoma formation (particularly if EAC closure was performed) 4
• The canal should be visualized regularly to assess healing and detect complications early 1, 5

Long-Term Considerations

• If external auditory canal closure was performed as part of the cancer surgery, CT imaging at 12-18 months post-operatively is reasonable, then only if clinically warranted 4
• Watch for breakdown of surgical closures, which may require revision with rotation skin flaps 4

Patient Instructions

Self-Care Guidelines

• Keep the ear completely dry during the healing period 2
• Do not attempt self-cleaning, as the post-surgical canal is extremely tender and vulnerable to damage 2, 3
• Have someone else administer any prescribed ear drops if possible, as only 40% of patients self-medicate appropriately 2, 3
• When administering drops: lie with affected ear upward, fill the canal, remain in position for 3-5 minutes, and use gentle tragal pumping 2, 3

Warning Signs

• Contact your surgeon immediately if you taste ear drops (suggests perforation), develop unexpected symptoms, or experience worsening pain 2, 3
• Report any signs of infection, increased drainage, or hearing changes promptly 2