What Is Ear Surgery?
Our ears are divided into three primary parts: the outer, middle, and inner ear. Ear surgery may be indicated when the function within any part of the ear is disrupted by congenital abnormality, injury, infection or other chronic disease processes.
Am I a Candidate for Ear Surgery?
Many children and adults are good candidates for ear surgery. Candidates for ear surgery include those with hearing loss or ear dysfunction due to a genetic or medical condition that can not be resolved with medical therapies, and for which surgical intervention is available.
What Are Some Common Ear Problems Treated at Our Center?
There are many common ear related diagnoses that are managed by neurotologists. The following list includes the most common ear problems:
- Hearing Loss: types of hearing loss include sensorineural, conductive, and mixed
- Ear Drum Perforation: a hole caused by infection or trauma
- Outer Ear Infection: also known as otitis externa or swimmer’s ear
- Acute Otitis Media: middle ear infection, a common recurrent problem in childhood but also occurring in adults
- Serous Otitis Media: fluid in middle ear leading to hearing loss
- Mastoiditis: an acute (sudden) or chronic (long term) infection involving the bone encasing the ear structures
- Cholesteatoma: a growth of skin into the middle ear and mastoid that over time erodes many important ear structures
- Otosclerosis: fixation of the stapes ear bone causing conductive hearing loss
- Vestibular Schwannoma: (aka Acoustic Neuroma) a benign tumor growing on balance nerve affecting balance and hearing
- Meniere’s Disease: inner ear problem causing vertigo and hearing loss
- Labyrinthitis: inflammation of inner ear usually caused by virus leading to hearing loss, vertigo
- Vestibular Neuritis: inflammation of balance nerve usually caused by a virus, leading to severe vertigo without hearing loss
Our team will perform a thorough consultation, examination, and audiogram (hearing test) to reveal the cause of ear problems. Once the cause of an ear problem is identified, an appropriate course of treatment to improve hearing function may be initiated. Further studies, including imaging, balance testing, and further specialized audiological testing may be necessary depending on the complexity of the problem.
Types of Ear Surgery
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 recurrent middle ear infections, persistent fluid in the middle ear space or pressure problems that may affect hearing. A small opening is made in the eardrum 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 during 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, and stapes (also called the hammer, anvil, and stirrup). These bones move together to transmit sound from the eardrum to the inner ear. One of the bones may become broken or displaced due to trauma, chronic infection, or damage from cholesteatoma, 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 either by placing a tiny prosthesis or by using native bone that is configured to re-establish a connection. 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 (0.8mm) 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 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. Surgery is required to place the internal component into the inner ear.
Baha® System Osseointegrated Temporal Bone Implant
An implantable bone conduction device can be used by individuals with conductive hearing loss, mixed hearing loss and individuals with unilateral hearing loss (single sided deafness). In a short outpatient surgical procedure, a small titanium implant is placed in the bone behind the ear. After healing and allowing the implant to osseointegrate (attach firmly) into 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, tinnitus, dizziness, facial nerve paralysis and with larger tumors, more serious problems affecting the function of the brain. The management approach to these tumors depends on multiple factors and is individualized to each patient. One option for treatment is surgical intervention to remove the tumor. Removal of the tumor is performed by a team of surgeons, including a neurotologist (an ear surgeon specializing in surgery involving the base of the skull) and a neurosurgeon. Different surgical approaches may be considered, including the translabyrinthine, middle fossa, and retrosigmoid approaches. The choice of approach depends on the size of the tumor and preoperative symptoms.
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.
Are Ear Surgeries Typically Successful?
The various ear surgeries that are performed by our team can successfully achieve the desired outcome. Every procedure has a unique objective. Before surgery, we discuss what our desired outcome is and the prognosis for achieving optimal results, be that a reduction in the frequency of ear infections or improved hearing.
Recovery from Ear Surgery
The extent of ear surgery recovery depends on the procedure that is performed. For example, a child who undergoes ear tube surgery may be back to their normal activity level the day after their procedure. Patients who undergo a more complex procedure such as a cochlear implant may need 1 to 2 weeks of recovery, during which they may experience mild pain, dizziness, and other symptoms.
Our team discusses what to expect from ear surgery and provides detailed post-operative instructions for each patient. We are also available to answer questions that may arise during recovery from ear surgery.