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During microsurgery of the ear, the technique selected for anesthesia should help to provide good operative field for the surgeon. An insect crawling in the ear while asleep is not uncommon and the experience of a crawling bug in the ear is not a pleasant experience.
Try to float the insect out by pouring mineral oil, olive oil or baby oil, coconut oil, hydrogen peroxide or simply by water into the ear.
Use a tablespoon of oil at room temperature, and slowly pour into the affected ear canal to drown the bug.
Do not attempt to use a pair of tweezers or ear swab to extract the insect, as this might cause the insect to crawl deeper into the ear resulting in further pain and complications. Otogenic complication as facial palsy and sensorineural hearing loss were more frequent in tuberculous otitis patients, than in cholesteatoma. The main audiolologic feature of TB is the deafness out of proportion with the apparent degree of development of disease seen in the otoscopy. Recent studies have shown that CT is the best modality available for the diagnosis of tuberculous mastoiditis; shows evidence of bone necrosis. The diagnosis of tuberculosis otitis media is based on demonstration of acid fast bacilli within granuloma in biopsy materials, with or without the culture of mycobacterium tuberculosis from the biopsy, aural discharge or aspirate of the middle ear. Drug Therapy: It includes 4 drug regimen (Isoniazid, Rifampicin, Pyrizinamide and Ethambutol). Modified Radical Mastoidectomy if any of the following complications develop: facial paralysis, subperiosteal abscess, labyrinthitis, mastoid tenderness and headache . The adenoids can be easly evaluated by nasal endoscopy, and if not tolerated, Xrays and Sinus CAT scans. Dental braces are devices used in orthodontics that align and straighten teeth and help to position them with regard to a person’s bite, while also working to improve dental health.
These braces can lead to undesirable complications during general anesthesia for any surgical procedures, if not cared properly. However, nasal obstruction due to enlarged turbinates and jaw deformity can also be major contributors to developing OSA. Nikhil suffers from obstructive sleep apnea due to a very large adenoid in the nasopharynx). A 10- to 15-degree head-up tilt increases venous drainage, keeps venous pressure low, and decreases venous bleeding. The most common situations in which an insect can enter the ear are: sleeping outdoors and when camping at night. Turn the head where the affected ear is in a down position to allow the oil, and hopefully the bug, to drain out of the canal together. Pull the earlobe gently backward and upward for an adult, backward and downward for a child.
Tuberculosis of the middle ear is characterized by painless otorrhoea, multiple tympanic perforations, abundant granulation tissue, bone necrosis and severe hearing loss. Also, fistulas of the labyrinth and facial canal bone destruction were also more frequent in tuberculous otitis than in cholesteatoma. Tuberculosis of middle ear is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment, in a patient with evidence of tubercle infection elsewhere followed by multiple tympanic membrane perforations, abundant granulation tissue, and bone necrosis, preauricular lymphadenopathy. In diagnosing tuberclulous otitis media, it is important to consider it as a differential diagnosis of chronic suppurative otitis media. Histology of tissues reveals granulations with epitheloid cells and multinucleated giant cells (Langhans giant cells), areas of central necrosis, lymphocytic infiltration, ulceration and signs of bone resorption.
Currently, the resistance to antitubercular drugs is a major problem and one of the main factors of difficulty in combating the disease. It is recommend that the anesthetist and concerned surgeon should enquire about the dental braces , during pre anesthetic assessment one should have more thorough inspection to find out any uncovered hooks.
He will make a thorough ear inspection to ensure that the canal has no lesions or irritations, in order to decrease the risks of infection.
Tuberculous otitis media should always be considered in differential diagnosis of chronic middle ear discharge that does not respond to usual treatment. A larger extent of temporal bone destruction was noticed on CT scans of the temporal bone in half of the patents with tuberculous otitis. There may be multiple perforations in the early stages, but they coalesce into a total tympanic membrane perforation accompanied by a pale granulation tissue. When surgery is combined with adequate chemotherapy, there is a good chance of healing with a dry ear with a good prognosis.
Pulmonary TB, or TB in the lung, can be spread from person to person through droplets in the air.
Late complications include facial paralysis, labyrinthitis, postauricular fistulae, subperiosteal abscess, petrous apicitis, and intracranial extension of infection. In the past, it was done to provide drainage, to control spread to central nervous system and to relieve facial paralysis. Now TB of the middle ear and Mastoid is suspected, and the polyps from the ear are sent for Histopathology. He might cut the loose fragments and correct it or may advise to remove it altogether and replace it after wards with new braces. In ENT practice, TB of Larynx, Lymph Node, Tonsil, Nose and Nasopharynx and Ear are rare but do occur. The advent of specific chemotherapy has challenged all this, and today surgery should be reserved for decompression of the facial nerve and for removal of necrotic material which might provide a nidus for the organism to remain out of reach of anti tuberculous therapy. In procedures such as stapedectomy and mastoidectomy, facial nerve monitoring may be performed, so it is important that neuromuscular paralysis has worn off. Sometimes, demonstration of sequestra in temporal bone during surgery will give a clue to diagnosis. The need for the patient to be immobile in operations on the ossicles requires deep anaesthesia.
Emergence from anaesthesia needs to be smooth so that there is no increase in venous pressure.
After mastoidectomy, a head bandage will be applied and there can be much movement of the head resulting in coughing and bucking on the endotracheal tube. This is not desirable due to the risk of bleeding, so a deep plane of anaesthesia is maintained until the bandage has been applied. Postoperative nausea and vomiting can disrupt grafts and prostheses and needs to be controlled.



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