Conditions & Treatments of the Ears
Myringotomy and Ventilation tube insertion: aka, tubes
Traditionally associated with young children, myringotomy and ventilation tube insertion, i.e. BMT, is a long standing procedure that treats otitis media, or inflammation of the middle ear. Otitis media results in ear infections that don’t go away with medication, middle ear fluid that doesn’t go away, and occasionally hearing loss and speech delays caused by frequent ear infections. The surgery involves making a small opening in the eardrum, and a small tube is placed in the opening. The procedure may be done in the office or under general anesthesia to relax and place the patient in a deep sleep. It takes about 10 to 15 minutes. When the surgery is over, there is a few-hours recovery period post-surgery, occasionally followed by a prescribed medication. After the surgery, you may notice fluid draining from your, or the patients ears, and may be a little bloody. This is normal, and will take a few days to drain fully. There may be mild pain as well, but it is safe to take non-aspirin pain reliever.
When a patient has a perforated eardrum, they experience hearing loss, and occasionally tinnitus and earaches. Typically, ENT specialist will watch if the eardrum heals on it’s own, but in some cases a surgery is required. This surgery is known as tympanoplasty, or, the surgical reconstruction of the eardrum and the small bones of the middle ear. The procedure is done under general anesthesia, either through the ear canal, with an incision in the ear, or an incision behind the ear. If done through the ear canal, the surgery takes half an hour to an hour, and if an incision is necessary, the surgery can take two and a half to three hours, and requires local or general anesthesia. After surgery you can expect some hearing loss from the packing used during the surgery, which will be removed or dissolve within a few weeks. It is important for optimal healing to avoid strenuous activity and nose blowing.
Severe ear infections can occasionally spread into the skull and temporal bone. When this happens, the mastoid air cells that sit behind the ear in a hollow space in the skull can become infected or involved. A mastoidectomy is performed to open these air cells and remove the infection. Mastoidectomy can also be performed to treat chronic otitis media, or ongoing ear infection in the middle ear, or cholesteatoma, the ingrowth of skin into the ear. A mastoidectomy is a procedure that is traditionally performed under general anesthesia, where a surgeon will access the mastoid bone through the ear or through a incision behind the ear, drill the mastoid bone, and remove infected mastoid air cells. The whole procedure typically takes a few hours.
Middle ear exploration, Ossicular Chain Reconstruction
The middle ear has three bones known as ossicles, and they help conduct and amplify outside sound to the inner ear. When the ossicles are damaged or there’s discontinuity in the ossicles, a patient experiences hearing loss. Damage can result from several sources, from chronic ear infections to tumors. The solution is a procedure known as ossicular chain reconstruction. This procedure takes one to two hours, during which a patient is placed under general anesthesia. The surgeon makes an incision behind the ear, and the eardrum is carefully elevated from the surrounding canal, and the ossicles carefully examined. If the ossicles are in good condition, one is removed, sculpted into proper shape, and repositioned to reestablish an intact ossicular chain. If one or more ossicles are not in good condition, a synthetic prosthesis is used. Recovery typically takes several hours in the recovery area, followed by a few weeks before improvement can be fully evaluated.
The stapes bone is a bone in the middle ear which is involved in the conduction of sounds vibrations to the inner ear. When the stapes bone is in a fixed position, a patient can experience severe conductive hearing loss. This is caused either by disease, or a malformed stapes. In either case, a stapedectomy can be performed, which involves removing the stapes bone and replacing it with a micro prosthesis. In successful surgeries, patients generally experience an improvement in hearing of about 20 dB. The procedure takes about an hour, and up to four weeks for the ear to completely heal.
Bone-Anchored Hearing Aid Placement
Hearing loss occurs either due to lack of function in the inner ear, or when sound has a problem reaching the nerve cells of the inner ear. With the latter, conventional hearing aids are not effective solutions to increase a patients hearing. Instead, the best solution is a hearing aid based on bone conduction. The bone-anchored hearing aid uses a surgically implanted abutment to transmit sound by direct conduction through bone to the inner ear, thereby passing the middle ear and external auditory canal. The surgery itself involves a small incision to place a titanium prosthesis in the skull, with the small abutment exposed to the outside skin. A sound processor sits on the abutment and sends sound vibrations to the titanium implant, thereby vibrating the skull and inner ear, stimulating the nerve fibers of the inner ear and allowing hearing.