Lookie here! A new ear canal!

On Thursday the 12th, a doctor in Portland removed most of the packing from Kai's new ear canal. He said the canal--though still quite swollen--looked good. No signs of infection.

There's still some packing in the new canal that will be removed in 2 more weeks, but as near as we can tell, the surgery was quite successful. Without his hearing aid, he could hear Keddrick and I whispering to him. In fact, he can hear me softly say his name from the dining room when he's in the living room. Woo hoo!

He's now wearing his hearing aid only on the left side. With an ear canal on the right and his hearing aid on the left, he has some directional hearing, too. Pretty dang cool.

He'll have an "official" hearing test in another two weeks and we'll post the results here.

A Tricky Business

So, about soaking that dressing off... much easier said than done. The thing seemed cemented in place. The skin graft is very close to the ear that we're supposed to keep dry. Doctors suggested we put a cup over his ear during bathtime, so we created the special head gear that you see above. It stayed on his head for about 2 minutes. I don't think we'll be patenting it anytime soon.

With a cup over his ear we had Kai lay back in the water with the skin graft submerged and the ear just above the water line. In our first try, we were able to remove a 1/2" x 2" piece of dressing. In later attempts, we tried this new and improved headgear (the top of a sippy cup taped over his ear):

Kai quickly got tired of this, so we tackled it every other day. We talked with doctors who suggested working the edges with a Q-tip soaked in hydrogen peroxide. Really, really tedious. Here's what's left of the dressing as of Sunday, Feb 8:

It looks pretty good and you can even see hair growing back the skin graft region.

Post-op Visit

At the post-op visit on Tuesday, the doctor clarified for us exactly what was going on in Kai's new ear canal. The picture below helps illustrate. The sponge is what you can see from the outside (shown in an earlier post). Behind the sponge is a lot more packing: a thick layer of gel foam, a silastic disk, and more gel foam. All of this packing keeps the ear canal open and the new membrane in place. (Originally, I thought stitches were used.)

At Kai's 3-week post-op visit (around Feb 12), a Portland doctor will remove the sponge, the first layer of gel foam, and the silastic disk. The last layer of gel foam will remain for another two weeks.

The doctor also *tried* to remove the dressing on the skin graft. He snipped the stitches that were originally holding it in place and removed the tape. Unfortunately, the dressing had slipped and the tape was stuck to part of the wound. Needless to say, removing the tape caused a lot of tears. Also, the dressing wouldn't come up even after the tape and stitches were removed--it had adhered to the raw skin. So... we get to soak it off. Ugh.

Almost there...

Trying to burn kid energy without running, jumping, swinging, leaping, and general roughhousing is, um, darn near impossible. So far, our strategy is to take them on walks in places where there’s plenty to see, but they always manage to work in some running and jumping anyway. On Friday, we took them to the Monterey Bay Aquarium (a fantastic aquarium). The kids had a great time—we were all mesmerized by the Outer Bay exhibit.

Yesterday we visited our friend Jonathan in Berkeley. The highlight for the kids was riding the steam engine trains in the Berkeley hills. The train rides and the drive to and from Berkeley helped keep the kids from getting too rambunctious. Here we are about to take a ride on a 7-1/2 inch gauge railway. It was a hoot.

Today, we went to San Francisco and wandered around Golden Gate Park. On the way home Kai complained that the skin-graft area itched a lot. He kept trying to rub the bandage covering it. We have a follow-up doctor visit tomorrow at noon and, hopefully, they can help us deal with the itchy skin graft. Then, we finally get to go home! It's been a really long week...

No Sneezing Allowed

As of Friday, our challenge with Kai has been keeping him mellow. The healing period is critical for success. We don’t want him to do anything to dislodge his new eardrum. He’s not supposed to suck through a straw or sippy cup—too much pressure on the ear drum. He’s also not supposed to blow his nose or sneeze. How does one not sneeze?! Of course, holding back a sneeze is even worse because it puts even more pressure on the ear drum. So far, we’ve been successful avoiding straws and sippy cups, but now Kai has a bit of a cold and blows his nose at will (even though we tell him not to) and, of course, he’s had a few bouts of sneezing. We’ll find out on Tuesday whether any of the stitches that hold the new eardrum membrane in place have slipped…

Post-Surgery Check-in

After we were cleared to leave the surgery center on Thursday, Kai slept all the way back to the hotel. Then we settled in for a 2-hour group nap. Kai was drowsy and obviously not feeling well most of the evening. He wasn’t able to keep any food down until about 10 o’clock that night. We gave him Tylenol with codeine on a regular schedule the rest of Thursday and Friday. Friday morning he was mostly back to normal and dying to be rid his purple turban. Our first stop was the doctor’s office where they cut the bandage off and re-dressed the skin graft and new ear canal.

And… here’s the new ear opening! The picture at left shows the arc of the incision line behind the right ear. It also shows the ear canal with a circular sponge filling it. The sponge helps ensure that the new hole and canal remain open; the sponge is also soaked with an antimicrobial or antiseptic solution. The hole is pretty large but, apparently, it’s purposefully that way because the opening will shrink as it heals.

I’ve spared you the gore of the skin graft: to the left of the incision is a 3 x 3 inch square that is covered with a clear plastic dressing that’s stitched in place. To me, it looks like a bloody mess but the doctor assured us it looks worse than it is. The doctor who prepped us likened the skin graft to “a really bad scrape”.

Here’s Kai at brunch afterwards with the surgery site bandaged:

Fortunately, there's a convenient gap between the skin graft area and the behind-the-ear incision

First Surgery: What They Did

Here's the procedure that Dr Joseph Roberson performed today for Kai (provided on a checklist they gave us):

Right Reconstruction of External Auditory Canal for Congenital Atresia, Tympanoplasty, Split-thickness Skin Graft, Ossicular Reconstruction for Congenital Anomaly, Continuous Intraoperative 7th Nerve Monitoring, Baseline Electrophysiologic Study, Microdissection

My understanding of the above: Dr Roberson created the ear canal with skin from the split-thickness skin graft, which they took from Kai's scalp on the right side of his head. For the tympanoplasty (creating the eardrum), Dr Roberson took a graft from a muscle in the jaw. As far as "ossicular reconstruction" (rebuilding the middle ear bones), it sounded like Dr Roberson didn't feel it was necessary. He said the stapes wasn't as flexible as he'd like but it was good enough. Apparently, the "7th nerve" is the facial nerve. They monitored proximity to it to ensure they didn't get too close and accidentally cause damage. I'm assuming "baseline electrophysiologic study" just means they tracked his vital signs and, frankly, I have no idea what they mean by "microdissection". I'll have to ask tomorrow.

Most importantly, the surgery went well and the prognosis is excellent. The only bit of trouble occurred when they removed the breathing tube--apparently, he woke up flailing and managed to remove the bandage around his head. To quiet him, the anesthesiologist gave him a healthy dose of Fentanyl, which Keddrick says is similar to morphine but has a shorter half-life. (Keddrick, the experienced surgical patient, says he personally prefers Demerol above all others.)

Here's Kai in the recovery room sleeping peacefully with his new purple turban:

He woke up gradually and was able to go home about two hours later.

Altogether, we were there for 6 hours. Seemed short to me but I'm still amazed that it's an outpatient procedure.

Here Kai is again sleeping with his favorite blanket ("flower") on the way back to the hotel: