MIDDLE ear surgery, especially stapedectomy, is usually performed through an incision in the skin of the external meatus which creates a tympanomeatal flap which is then lifted forward to expose the middle ear (tympanotomy).
The external auditory meatus is deep and covered by thin skin that is easily traumatized on cleaning and disinfection. It contains ceruminal glands and hair follicles which harbor infection so deep that it cannot be completely eradicated. Shea says1:
Sterilization of the ear canal for surgery is difficult, and I agree with House, who has recently pointed out that even with the most vigorous efforts the ear canal cannot always be sterilized and cultures taken will demonstrate some organisms after the sterilization is completed in about 25% of patients. He believes that the multiplication of these organisms may be the cause of some of the early cochlear losses that occur after surgery from an inapparent
ABDEEN MO. Postauricular Sulcus Approach in Middle Ear Surgery. Arch Otolaryngol. 1966;84(6):612–615. doi:10.1001/archotol.1966.00760030614004
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