Surgical Procedures for Ear and Skull Base
For many diagnoses that affect the health of the ear and hearing, or the health of structures near the ear, surgery may be an option. The following are some of the many ear related surgical procedures offered at the ENT Faculty Practice.
Ear tubes, also known as tympanostomy tubes or pressure equalization tubes (PETs) are placed in children and adults to treat problems of recurrent middle ear infections or persistent middle ear fluid or pressure problems that may affect hearing. A small opening is made in the ear drum and a tiny tube is placed through the opening to relieve fluid and pressure problems. In adults, this procedure can be performed in the office. For children and patients with more sensitive ears or difficult anatomy, tubes are placed while the patient is under anesthesia in the operating room.
Tympanoplasty is a procedure to repair a perforated (hole of) eardrum. Perforated eardrums occur for a variety of reasons including a history of infections, pressure problems and prior trauma. The problem is often associated with hearing loss and may lead to increased problems with infections and drainage from the ear. Repair of the eardrum can be completed in an outpatient surgery to restore the health and safety of the ear.
The mastoid is the bone directly behind the ear. It is normally composed of a honeycomb of air cells and bone that surrounds the fragile middle and inner ear structures. In situations of chronic infection or disease processes such as cholesteatoma, the air cells become filled with fluid and/or soft tissue, and surgery may be required to resolve the problem. A mastoidectomy is completed to remove the infection or cholesteatoma, and restore the health of the ear. This surgery is most often completed as an elective outpatient surgery. Rarely, in cases of severe and acute mastoid infections (acute mastoiditis), the patient may be hospitalized and the surgery completed urgently.
Ossicular Chain Reconstruction (Ossiculoplasty)
The middle ear consists of three bones known as the malleus, incus, stapes (also called the hammer, anvil, or stirrup). These bones move together to conduct sound from the ear drum to the inner ear. Due to trauma, chronic infections or damage from cholesteatoma, one of the bones may become broken or displaced, resulting in a conductive hearing loss. In this situation, a procedure known as an ossiculoplasty can be completed to repair the problem. This repair is usually achieved by placing a tiny prosthesis, or artificial ear bone. The surgery is an elective, outpatient procedure.
Laser stapedotomy is a surgery completed most often for patients with otosclerosis and less frequently for other disease affecting the stapes bone. In otosclerosis, patients develop gradual fixation of the stapes (stirrup) bone with associated progressive conductive hearing loss. Using a laser, a tiny (.8mm) opening is made in the base of the stapes, and a stapes prosthesis is placed to repair the problem and restore the hearing. This finesse surgery is completed as an elective, outpatient surgery and may be done under sedation or general anesthesia depending on the patient’s preference.
A cochlear implant is s specialized technology that allows individuals with severe to profound hearing loss to hear and understand sound. The cochlear implant electrically stimulates nerve cells in the inner ear (cochlea) which then sends a signal up to the hearing nerve to the brain. In doing so, the cochlear implant bypasses the problem affecting people with severe to profound hearing loss that prevents them from benefiting from hearing aids. Both children and adults with severe profound hearing loss may be candidates for a cochlear implant. A surgery is required to place the internal component into the inner ear.
Baha® System Osseointegrated Temporal Bone Implant
The Baha® System is a specialized bone conduction device that can be used by individuals with conductive hearing loss, and individuals with unilateral hearing loss (single sided deafness). In a short outpatient surgical procedure, a small titanium implant is place in the bone behind the ear. After healing and allowing the implant to attach to osseointegrate (attach firmly to) the bone, a specialized hearing processor can then be connected to the implant, conducting sound through the bone, allowing the patient to hear.
Acoustic Neuroma (Vestibular Schwannoma) Surgery
An acoustic neuroma, also known as a vestibular schwannoma, is a tumor arising from the hearing or balance nerve. As the tumor grows it can cause hearing loss, dizziness, facial nerve paralysis and with larger tumors, more serious problems affecting the function of the brain. One option for treatment is surgical intervention to remove the tumor. Surgery is performed with a team effort of the neurotologist and the neurosurgeon. Different surgical approaches may be considered, depending on the size of the tumor and preoperative symptoms and include translabyrinthine, middle fossa and retrosigmoid approaches
Sometimes a patient is not a candidate for reconstructive surgery. In the event of a burn injury, cancer resection, or congenital condition such as microtia, an alternative to surgery is prosthetic treatment. Our staff anaplastologist, Erin Donaldson, will custom fit, sculpt, paint, and deliver a prosthesis – a mirrored replica - for the affected side ear. Our prostheses are fabricated from medical grade silicone, and are worn daily much like a pair of eyeglasses. The prosthesis is worn by using skin adhesives or attached through osseointegrated implants. Our surgical team will discuss these options with you before beginning prosthetic treatment.
» For information on Facial Prosthetics, click here