Common Surgical Procedures - Ear surgery

Surgical treatment of the ear usually is directed toward restoring the function of normal hearing which may have been lost or impaired by disease or injury. The eardrum, or tympanic membrane, can be perforated or ruptured by direct injury, by the shock waves of an explosion, or by an infection of the middle ear. Infection or injury also can disrupt hearing function by damaging the ossicles, a chain of tiny bones that transmit sound waves from the eardrum to the inner ear. Disease, aging effects, and exposure to loud noises can cause hearing loss or impairment.

Surgery of the ear usually involves working with the middle ear, the compartment between the eardrum and the inner ear, which contains the nerve endings that carry impulses to the auditory centers of the brain. The middle ear contains three ossicles, known by their common names of hammer , anvil , and stirrup —terms that suggest their functions in translating movements of air molecules into the vibrations the brain understands as sounds.

Otitis Media

One common disease of the middle ear is otitis media, which can occur by infection from a number of different kinds of organisms. Otitis media also can develop from secretions or fluids such as milk being forced into the ear through the Eustachian tube, particularly in infants who are fed while they are in a reclining position. The symptoms of otitis media are pain in the ear, fever, and loss of hearing; a small child may indicate the symptoms by crying and tugging at the ear.

Surgical Procedure

Many cases of otitis media respond to medical treatment, such as the use of antibiotics, but for patients who suffer severe pain or who have middle ears filled with pus, a surgical procedure called myringotomy is performed. “Myringotomy” means simply perforating the eardrum. But the operation usually is peformed in a hospital, under a local anesthetic, and with great care to avoid disturbing the ossicles or other ear structures beyond the eardrum. The middle ear is drained and the eardrum either heals spontaneously or can be subsequently repaired with a graft from the patient's own tissues.

Surgery to Correct Hearing Loss

Occasionally surgery is required to correct a conductive hearing loss involving the structures of the middle ear. Such problems happen more frequently among older persons because of abnormal tissue growths that in effect “freeze” the ossicles, so that they no longer work with normal flexibility. Ossicular disorders also can occur in younger persons, including children, because of congenital defects, injury, or repeated infections, as of otitis media. The exact procedure for restoration of hearing depends upon the type of disorder. If one of the ossicles has slipped out of position or has become rigidly attached to another structure, like the tympanic membrane, the tiny bones can be repositioned or freed from the tissues that may have immobilized them. It is not unusual for the surgeon, working in a space about the size of a pea and viewing his progress through a microscope, to literally take the middle ear structures apart, rebuild the organ with bits of plastic or metal shaped like the ossicles, and reconstruct the eardrum with tissue grafts. This kind of surgery is called microsurgery .

Inner Ear Disturbances

Disorders of the inner ear usually are treated with medications. Surgery in that area is seldom performed unless there is a great risk to the life of the patient. Little can be done to restore hearing loss caused by nerve deafness except with hearing aids; these are designed to pick up sounds on the affected side of the head and route the sounds by electronic circuitry to an area where they can be picked up by remaining functional auditory nerves.