What is
Middle Ear Procedures?
Many children get middle ear infections. This is known as
otitis media (OM). Otitis media
is inflammation located in the middle ear.
Otitis media can occur as a result of a
cold, sore throat, or respiratory infection.
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Effects
of Middle Ear Procedures
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.
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Candidates
for Middle Ear Procedures
The infections are most common in kids
between the ages of 6 months and 2 years,
although children of all ages may
occasionally suffer from OM. Some kids are
particularly susceptible because of
environmental and lifestyle factors. These
risk factors include attendance at a large
group child care, secondhand tobacco smoke,
and taking a bottle to bed.
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.
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Your
Consultation
The preparation depends upon the type of ear
surgery performed. For many procedures,
blood and urine studies and hearing tests
are conducted.
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The Middle Ear Procedures
Procedure
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.
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.
Cochlear implants -
Cochlear implants stimulate nerve ends
within the inner ear, enabling deaf children
to hear. The device has a microphone that
remains outside the ear, a processor that
selects and codes speech sounds, and a
receiver/stimulator to convert the coded
sounds to electric signals that stimulate
the hearing nerve and are recognized by the
brain as sound. During surgery, an incision
is made behind and slightly above the ear. A
circular hole is drilled in the bone to
receive the device's internal coil. The
mastoid bone leading to the middle ear is
opened to receive the electrodes. The
internal coil is inserted and secured,
followed by the electrodes. The wound is
stitched up and when it heals, an external
unit comprised of a stimulator with a
microphone is worn behind the ear. Performed
in a hospital under general anesthesia, the
operation takes about two hours and usually
requires a hospital stay overnight. The
patient can resume normal activities in two
to three weeks.
Ear surgery for tumors -
Some ear tumors can be very serious and
should be removed surgically. For a tumor on
the skin of the ear canal, the skin is
removed surgically, the bone beneath it is
drilled away and a skin graft is placed in
the ear canal. If the tumor is near the
eardrum, the skin of the ear canal and the
eardrum are removed along with the bone
surrounding the ear canal. A skin graft is
placed on the bare bone. For basal cell
cancers and low grade glandular
malignancies, surgical resection of the ear
canal is adequate. Squamous cell carcinoma,
a serious form of cancer, of the external
ear canal requires radical surgery, followed
by radiation therapy. Cholesteatoma,
a benign tumor caused by an infection in a
perforated eardrum that did not heal
properly and can destroy the bones of
hearing, is removed with microsurgery.
Mastoidectomy is performed for mastoiditis,
an inflammation of the middle ear, if
medical therapy does not work. Petrous
apicectomy is performed to drain the petrous
apicitis, the bone between the middle ear
and the clivis.
Ear surgery for congenital ear defects -
Congenital atresia, the absence of the external ear canal,
and congenital microtia, abnormal growth of
the external ear, often occur together,
although atresia can occur without microtia.
Surgery to reconstruct the ear usually takes
place when the child is four or five years
old and may require several operations. A
facial plastic surgeon and an ear surgeon
work together, repairing the microtia first
and then the atresia. During surgery, a bony
opening is created over the bones of
hearing. The surfaces of the bony ear canal
are then relined with a skin graft from the
thigh or abdomen. Tissue from behind the
eardrum is used to create a new eardrum. In
many cases, the middle ear will also need to
be reconstructed. Surgery is performed in a
hospital under general anesthesia.
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Recovery
The type of aftercare depends upon the type of surgery
performed. In most cases, the ear(s) should
be kept dry and warm. Non-prescription drugs
such as acetaminophen can be used for pain.
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Risks
The type of risk depends on the type of
surgery performed. Total hearing loss is
rare.
Auditory - Relating to the sense of the organs of hearing.
Cholesteatoma - A cystic mass of cells in the middle ear, occurring as a
congential defect or as a serious
complication of a disease or traumtic
condition of the ear.
Otologic - Relating to the study, diagnosis, and treatment of diseases of the ear
and related structures.
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Frequently Asked
Questions
Q: What causes otitis media?
A:
Middle ear infections are usually a result
of a malfunction of the eustachian tube, a
canal that links the middle ear with the
throat area. The eustachian tube helps to
equalize the pressure between the outer ear
and the middle ear. When this tube is not
working properly, it prevents normal
drainage of fluid from the middle ear,
causing a buildup of fluid behind the
eardrum. When this fluid cannot drain, it
allows for the growth of bacteria and
viruses in the ear that can lead to acute
otitis media.
Q: What are the different types of otitis
media?
A:
Different types of otitis media include the
following:
-
acute otitis media (AOM)
- the middle ear infection occurs
abruptly causing swelling and redness.
Fluid and mucus become trapped inside
the ear, causing the child to have a
fever, ear pain, and hearing loss.
-
otitis media with effusion (OME)
- fluid (effusion) and mucus continue to
accumulate in the middle ear after an
initial infection subsides. The child
may experience a feeling of fullness in
the ear and hearing loss.
Q: What happens when otitis media is left
untreated?
A:
Untreated otitis media can result in any/all
of the following:
-
infection in other parts of the head
-
permanent hearing loss
-
problems with speech and language
development
Q: What are the symptoms of otitis media?
A: Symptoms of
otitis media include:
-
pulling or rubbing the ears because of
ear pain
-
fever
-
fussiness or irritability
-
fluid leaking from the ear
-
changes in appetite or sleeping patterns
-
trouble hearing
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