head turned to the side, with the affected ear up. Great care must be taken in alignment
of the patient, especially if the procedure is time consuming.
(2) In the presence of infection, disposable sheets and towels should be
used. An opening can be readily made with scissors in the sterile sheet or towel to
expose the operative site. A standard ear pack is used.
(3) Three towels are folded lengthwise and placed around the operative site.
The first one is placed horizontally above the ear, the second towel is placed diagonally
on the outer prepared skin area surrounding the ear, and the third vertically in front of
the meatus. A folded fenestrated sheet is unfolded over the patient and table, with the
operative site in view through the opening.
(4) The draped tables with sterile instruments and the operating microscope
are positioned around the patient. For example, if the operation involves the left ear,
the sterile instrument table is placed near the left side of the operating table. The scrub
usually sits or stands near the instrument table and passes the instruments to the
surgeon in such a manner that he does not have to turn away from the operative
(5) All safeguards should be taken to prevent explosive hazards. This is
most important because there are many electrical appliances in use during otological
d. Anesthesia for ear surgery may be local or general depending upon the
severity of the surgery to be performed and the age of the patient.
e. The dressing applied following surgery is usually one of two types. For
internal canal work, an ear wick may be inserted. For surgery on the mastoid sinuses or
any posterior approach, a large compression type dressing commonly referred to as a
mastoid dressing is applied.
1-21. INSTRUMENTS AND SUPPLIES
Check the surgeon's card carefully, and make sure that all instruments and
equipment are assembled. The operating microscope, suctioning equipment, and drill
are often required. All equipment must be in working order. Since the operating
microscope is used in such close proximity to the surgical wound, it is draped with
disposable microscope drapes before use. Electric cautery equipment is also
1-22. INCISIONAL APPROACHES
a. The endaural (vertical) incision frequently is used for temporal operations,
except for simple mastoidectomy. The first incision extends from the superior meatus