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Ear surgery
Definition
Ear surgery is the treatment of diseases, injuries, or deformations of the ear by operation with instruments.
Purpose
Ear surgery is performed to correct certain types of hearing loss, and to treat diseases of, injuries to, or deformities of the ear's auditory tube, middle ear, inner ear, and auditory and vestibular systems. Ear surgery is commonly performed to treat conductive hearing loss, persistent ear infections, unhealed perforated eardrums, congenital ear defects, and tumors.
Ear surgery is performed on children and adults. In some cases, surgery is the only treatment; in others, it is used only when more conservative medical treatment fails.
Precautions
The precautions vary, depending on the type of ear surgery under consideration. For example, stapedectomy (removal of parts of the middle ear and insertion of prosthesis parts) should not be performed on people with external or middle ear infection or inner ear disease. For people with complete hearing loss in the other ear, it should be performed cautiously. Microsurgery for the removal of a cholesteatoma (a cyst-like mass of cells in the middle ear) should not be performed on patients who are extremely ill or have other medical conditions. Tympanoplasty (any surgical procedure on the eardrum or middle ear)
Description
Most ear surgery is microsurgery, performed with an operating microscope to enable the surgeon to view the very small structures of the ear. The use of minimally invasive laser surgery for middle ear procedures is growing. Laser surgery reduces the amount of trauma due to vibration, enhances coagulation, and enables surgeons to access hard to reach places in the middle ear. Laser surgery can be performed in an office operating suite. Types of ear surgery include stapedectomy, tympanoplasty, myringotomy and ear tube surgery, ear surgery to repair a perforated eardrum, mastoidectomy.
- Stapedectomy
To restore hearing loss, which is usually due to otosclerosis, stapedectomy is performed. Stapedectomy is the removal of all or part of the stapes, one of the bones in the middle ear, and replacement with a tiny prosthesis. An incision is made in the middle ear, the small bones are identified, and the stapes is removed. The stainless steel wire and cellulose sponge prosthesis is inserted, blood and fluid are drained, and the wound is closed. Performed in a hospital or outpatient surgical facility under local or general anesthetic, full recovery takes about three weeks but hearing should improve immediately. - Tympanoplasty
Tympanoplasty is performed to reconstruct the eardrum after partial or total conductive hearing loss, usually caused by chronic middle ear infections, or perforations that do not heal. This is usually a same day surgery, performed under either local or general anesthesia. After making an incision in the ear to view the perforation, the ear drum is elevated away from the ear canal and lifted forward. If the bones of hearing (ossicular chain) are functioning, tissue is taken from the ear and grafted to the eardrum to close the perforation. A thin sheet of silastic and Gelfoam hold the graft in place. The ear is stitched together, and a sterile patch is placed on the outside of the ear canal. Tympanoplasty is successful in over 90% of all cases. The need for ossicular reconstruction (reconstruction of tiny bones of the middle ear) is sometimes known before surgery and even when identified during surgery, can usually be done while reconstructing the eardrum. If the gap between the anvil bone and the stapes is small, a small piece of bone or cartilage from the patient can be inserted; if is is large, the incus bone is removed, modelled into a prosthesis, and reinserted between the stapes and the malleus. Reconstruction could also be achieved by inserting a strut made from artificial bone. For tympanoplasty with ossicular reconstruction, the patient usually stays in the hospital overnight. The recovery period is about four weeks. - Myringotomy and ear tube surgery
Myringotomy and ear tube surgery is performed to drain ear fluid and prevent ear infections when antibiotics don't work or when ear infections are chronic. The process normalizes pressure in the middle ear and decreases fluid accumulation. It is most commonly performed on infants and children, in whom ear infections are most frequent, and may be done on one or both ears. The surgeon makes a small hole in the ear drum, then uses suction to remove fluid. A small ear tube of metal or plastic is inserted into the ear drum to allow continual drainage. The tube prevents infections as long as it stays in place, which varies from six months to three years. When the tube falls out, the hole grows over. As many of 25% of children under the age of two who need ear tubes may need them again. Myringotomy and ear tube surgery is performed in a hospital, using a general anesthetic for most children and a local anesthetic for older children or adults. No anesthetic may be used for infants. The procedure usually takes about two hours. Most patients can go home the same day; children under three years of age and those with chronic diseases usually stay overnight. - Ear surgery for a perforated eardrum
Ear surgery for a perforated eardrum is only performed in rare cases where it does not heal on its own. In most cases, this is performed in a surgeon's office using a topical anesthetic. The surgeon scratches the undersurface of the eardrum, stimulating the skin to heal and the eardrum to close. A thin patch placed on the eardrum's outer surface allows the skin under the eardrum to heal. - Mastoidectomy
Mastoidectomy is performed when the ear continues to remain infected. It is useful for removing infected tissue from the bone cavities surrounding the ear.
Physicians at ENTcare are trained to care for your ears' surgical and medical needs.