Chronic
disease of the middle ear, the space between the ear drum and the inner ear
organs of hearing, is a common problem. There is a wide range of causes for
middle ear problems. It may result from a long lasting infection, or from an
injury to your ear. The injury may be as mild as irritation from a Q-tip or
as severe as a skull fracture, a major explosion near your ear, or acid entering
your ear. However, there are common symptoms to all of these problems of the
ear:
If you have seen your primary care doctor, he/she may have told you that there is a problem in your middle ear and has treated you with various medications. If the problem has continued, more serious symptoms would be:
Our office has four board certified ear, nose and throat doctors (otolaryngologists) who will take your history, examine you and explain their findings. Our certified audiologists will do hearing tests. Other recommendations may require x-rays or additional testing at a medical facility. Hopefully, this article will give you a nice overview of hearing loss and possible treatments for different ear problems.
HOW YOUR EAR WORKS
There are three main parts to your ear:
When sound travels and hits the eardrum, it moves the three small bones causing them to vibrate which transfers energy into the inner ear. Tiny hairs in the inner ear are stimulated and change sound energy to nerve signals. From the inner ear, the sound signals travel along the auditory (hearing) nerve to the brain for interpretation of sound and words.
HEARING LOSS
There are two types of hearing loss, conductive and sensorineural. Both of these can result from injury, infections, and certain types of growths in your ear.
Conductive hearing loss
results from problems occurring anywhere from the outer ear to the middle ear.
This can be an outer ear problem, such as the ear canal being swollen from infection,
wax blocking the ear canal, or a growth or foreign body in the ear canal. It
can be an eardrum problem, like a large perforation or hole in the drum. Other
causes include fluid or infection in the middle ear, or damage of the middle
ear bones.
Anything that prevents normal conduction of vibration to the eardrum and the
three small bones causes decreased hearing.
Sensorineural hearing loss
occurs when the nerve cells of the inner ear or the nerve going to the brain
have decreased in their function. The sound waves that enter the inner ear are
not transmitted to the brain as well as desired. Common causes include:
After an evaluation, treatment would be discussed with the patient or parent(s) of a child. Depending on the cause of hearing loss and the type of disease, options include medications, the use of a hearing aid, or surgery.
Surgical Treatment of Middle Ear Problems
There are many different
surgical procedures for ear problems, but the most common ones include:
Tympanoplasty - repairing a hole in the tympanic membrane
Mastoidectomy - removing infected tissue & abnormal bone
Ossicular reconstruction - to repair some or all of the middle ear bones
Stapedectomy - for stiff or deteriorated bones
The benefits of surgery and the possible risks would be discussed prior to the surgery in relationship to the problem that exists. While each type of ear surgery has specific benefits and risks, the common benefits include creating a safe, closed eardrum, improved hearing, and less probability of ear drainage or infections. Possible risks include:
Description of Ear Surgeries
Tympanoplasty - repairing a damaged eardrum or one with a hole in it.
A hole in the ear drum can
result from injury or infection, and often will heal by itself. However, when
the hole does not heal, there is often hearing loss and chance of infection
and drainage. The surgical repair prevents future infections from outside contamination
such as water getting into the middle ear. It also prevents skin from the outside
of your eardrum from growing into the middle ear causing a cholesteatoma. (Cholesteatoma
will be discussed later.)
During surgery, the patient is usually asleep with a general anesthetic. The
operation will be performed through your ear canal or through an incision made
behind your ear. The eardrum is repaired with your own tissue, known as the
graft. This graft tissue could be:
The graft is held in place
with a soft absorbing material called Gelfoam. Gelfoam is a cellulose product
used since the 1960's which is well tolerated in patients. This prevents the
graft from slipping and helps heal the perforation.
The whole procedure usually takes 1½ -3 hours, and generally patients
can go home the same day.
Mastoidectomy - removing tissue growth, infection, diseased tissue lining, and infected bone from an area above and behind the middle ear.
The mastoid bone is made
up of small cells, which are called air cells. Infection may spread through
these areas and go into several small areas. The growth of skin, called cholesteatoma,
may grow in several of these irregular areas. The cholesteatoma will often destroy
the middle ear bones, invade into the facial nerve, the inner ear and even progress
toward the brain-making it very necessary to remove this.
During mastoid surgery, the patient always has general anesthesia. The operation
is performed through an incision behind your ear although there are times that
it may be done with incisions along the ear canal. The procedure takes 1½
-3 hours and is often done with a tympanoplasty and ossicular reconstruction.
Depending on the amount of disease, the operation could take 4-5 hours. Patients
may need to stay overnight after surgery, but often can go home the same day.
Ossicular reconstruction - repair of some or all of the middle ear bones.
If the middle ear bones
have been destroyed or are completely surrounded by infection, diseased tissue
or cholesteatoma, one or more of them may need to be removed to get at the disease.
The bones are replaced with synthetic bones. The most common bone that needs
to be replaced is the incus. With each additional bone that needs replacing,
the chance for improved hearing worsens. More specific percentages will be discussed
in the office by the doctor depending on the overall condition of your ear.
The patient usually has general anesthesia or possibly a local anesthetic with
sedation. The operation takes about 2 hours depending on whether it is combined
with other ear procedures.
GENERAL INFORMATION CONCERNING SURGERY
Once a surgery date has been scheduled, the proper preoperative scheduling will be done. The hospital will contact you about any anesthetic issues, and any heart, blood pressure or diabetic medications that you need to continue.
You will need a ride home after surgery.
There will be NO eating or drinking after midnight the day before surgery.
The hospital or our office will tell you exactly when and where to arrive prior to surgery. Written information will also be given to you at our office concerning this.
Once you arrive, the hospital nurses will be taking your history and the anesthesiologist will be talking to you during the preoperative time.
Immediately after surgery, you will wake up in the recovery room, where you are watched very closely. From there you will be going to a unit that treats patients for day surgical procedures.
Once you are sent to this hospital unit, your family & friends are allowed to be with you.
You will probably have some type of dressing/bandage over your ear or possibly completely around your head. Your ear will feel full because there is packing in your ear.
Once you are awake enough and are able to drink fluids and eat food, the nurses will allow you to be discharged from the hospital. With ear surgery, this is usually 3-4 hours after your procedure.
The nurses will check you for the following things prior to allowing you to go home:
What you can do at home:
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Robert Petroelje,
MD |