Also called tympanostomy, myringotomy involves the removal of fluid from the eardrum and may be supplemented with tube insertion if drainage continues despite medication. Myringotomy with or without tube implantation is the most frequently performed ear operation and the second-most common surgical procedure inchildren younger than two years of age, after circumcision. Surgery is recommended for patients with hearing loss and the presence of fluid for four months or longer.
Myringotomy consists of making an incision in the eardrum and vacuuming out fluid under general anesthesia. Even the youngest patients typically recover within a few hours, with pain relief medications taking the form of acetaminophen, codeine or topical anesthetic ear drops. After surgery most patients experience a full return of hearing ability as well as less pain, fewer infections and increased speech capacity. The hole in the eardrum should close on its own and drainage should cease, although 20-30% of patients require a second procedure. Tubes are usually removed after several months, although they may remain in place for a few years or even permanently. Patients must be careful to avoid water contamination of the tubes.
Complications are rare and usually minor but may include infection (usually resolved with antibiotics) and additional surgery to correct perforation of the tympanic membrane or replace the tympanostomy tubes.
Located behind the ear, the mastoid bone connects to the middle ear and, when
healthy, is filled with air. Infection or disease in the ear or elsewhere can cause the mastoid to fill with fluid, mucus or excess tissue (such as a cholesteatoma, a benign tumor that may grow out of a healing perforated ear drum and cause hearing damage). When medications and other non-surgical treatments such as antibiotics or professional cleaning fail to resolve the problem, mastoidectomy may be performed.
Complications from surgery are rare but may include drainage from the ear, infection, temporary dizziness or loss of taste on one side of the tongue, hearing loss and, rarely, nerve injury to the side of the face operated upon.
Tympanoplasty is an elective, ambulatory microsurgical procedure performed to close a perforation (hole) in the tympanic membrane (ear drum) when non-surgical methods are ineffective. Perforations may be caused by infections, injuries, flying with a cold and use of cotton swabs; symptoms include drainage or bloody discharge from the ear, hearing loss, dizziness when water enters the ear and frequent ear infections. Antibiotics, decongestants, ear drops and abrasion with a small hook are often tried before surgery is recommended.
Surgery may not be recommended for very young children or patients with chronic sinus or nasal problems such as severe allergies, acute infection in the sinuses or nose, or poorly controlled diabetes or heart disease.
Tympanoplasty can require either local or general anesthesia and may be performed in conjunction with mastoidectomy if infection is present there. An incision is made either in the ear canal or behind the ear, depending on the size and depth of the perforation. The damaged ear drum is lifted and the perforation located; skin from behind the ear or from the ear lobe (tragus) is removed, thinned, dried and applied to the ear drum.
The bones of the middle ear are examined for damage. In a supplemental procedure known as ossicular reconstruction, the damaged or eroded bones may be bridged with a bone or cartilage graft, re-shaped using an operating microscope, or strengthened by the implantation of an artificial bone strut made of hydroxy apatite to reduce risk of rejection. Another, rarer ossicular reconstruction procedure called malleus fixation involves the reshaping of the malleus bone (“hammer”).
The incision is then closed. Stitches beneath the skin will be required if the ear was opened.
Patients often return home in about three hours after tympanoplasty or the next morning if ossicular reconstruction is performed, and may return to work within the week. Swimming and showering without ear plugs may be resumed in three to four months. Antibiotics or Tylenol usually relieve any post-surgical pain. The graft is checked at ten days and again at three weeks, with a hearing test performed after four to six weeks. The perforation heals properly in over 90% of cases. Failure may result from immediate infection, water getting into the ear or displacement of the graft after surgery.
Complications are uncommon but may include temporary dizziness, tinnitus, loss of taste on one side of the tongue, facial nerve injury and further hearing loss.
Stapedectomy is an elective microsurgical procedure that replaces the stapes bone with a prosthesis (artificial bone) to counteract calcium deposits in the ear associated with otosclerosis.
Surgery is performed under general or local anesthesia and can be done through the ear canal. The ear drum is raised and the middle ear opened, revealing the calcium deposit, which is then broken up with a laser. The remains of the vaporized stapes bone are removed and the bone is replaced. A tiny sample of tissue from behind the ear lobe is grafted to promote healing, and the incisions are closed.
Complications are rare and depend on the patient’s anatomy. These may include temporary loss of taste on one side of the tongue, dizziness, tinnitus (ringing in the ears) and, rarely, facial nerve paralysis or partial or total hearing loss requiring the use of additional surgery or a hearing aid.
Cochlear implants — tiny electronic devices surgically implanted behind the ear — have given the gift of hearing to thousands of children and adults. Cochlear implants are not hearing aids, which amplify sounds the ear already hears; rather, while the implants do not restore a deaf person’s hearing, they help a person to understand the sounds in their environment, such as speech. The implant consists of a microphone to pick up sound, a speech processor to process that sound, a transmitter/receiver which converts the sound information to electrical impulses, and electrodes that send those impulses to the brain. Over 20,000 adults and children in the U.S. have benefited from cochlear implants. Implants can be useful for adults who associate sounds made through the implant with sounds they heard earlier in life when their hearing was better; early implantation and therapy can help children as young as two years old to learn speech and other auditory comprehension skills.