MIDDLE EAR SURGERY. For Better Health and Hearing

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Rodney Thornton
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1 MIDDLE EAR SURGERY For Better Health and Hearing

2 Help for Ongoing Ear Problems Your doctor has found a problem with your middle ear. This is a part of the ear that you can t see. You may have taken medication, but you haven t gotten completely better. You have more options, though. Middle ear surgery may improve your hearing and relieve other symptoms. Read this booklet to find out more about middle ear surgery. Common Problems and Symptoms Your middle ear may have been injured or infected recently. Or your middle ear may have been affected by certain growths or bone disease. Any of these problems may cause symptoms such as: Hearing loss in one or both ears. Fluid draining from the ear. Pain, pressure, or discomfort in the ear. Ringing in the ear. Hearing difficulties are a common symptom of middle ear problems. Several middle ear problems can be corrected with surgery. 2

Your Evaluation You probably have seen a doctor who specializes in ear problems either an otolaryngologist (ear, nose, and throat specialist) or an otologist (an otolaryngologist who focuses on ears).

Surgery May Help Some middle ear problems go away with medication, but others do not. In some cases, the problem must be fixed with surgery. You may need more than one surgery.

3 Your Evaluation You probably have seen a doctor who specializes in ear problems either an otolaryngologist (ear, nose, and throat specialist) or an otologist (an otolaryngologist who focuses on ears). This doctor probably examined your ears, nose, and throat. You also may have had hearing and ear imaging tests. These are used to find the source of ear problems. Surgery May Help Some middle ear problems go away with medication, but others do not. In some cases, the problem must be fixed with surgery. You may need more than one surgery. Sometimes more than one surgery is done at the same time. Sometimes a series of surgeries is done at different times. Using the boxes below, ask your doctor to check off the surgeries you may need. These surgeries are described in detail later in this booklet. Tympanoplasty repairs a damaged eardrum (page 8). Mastoidectomy removes infected bone (page 9). Ossicular chain reconstruction repairs or replaces some or all middle ear bones (page 10). Stapes surgery repairs or replaces the stapes bone (page 12). 3

How the Ear Works The middle ear is an air-filled chamber. The eardrum (tympanic membrane) separates the outer ear from the middle ear. The eardrum and middle ear move sound on to the inner ear.

4 How the Ear Works The middle ear is an air-filled chamber. The eardrum (tympanic membrane) separates the outer ear from the middle ear. The eardrum and middle ear move sound on to the inner ear. When the ear is healthy, air pressure remains balanced in the middle ear. Disease or injury can affect how well the middle ear works. How You Hear The outer ear: Sound enters and is funneled to the eardrum. This makes the eardrum vibrate. The middle ear: Vibrations from the eardrum make three tiny bones move. These bones are the malleus, incus, and stapes. The inner ear: Movement of the ear bones is transformed into electrical signals. These signals travel along the auditory (hearing) nerve to the brain. The mastoid bone surrounds the middle ear. The external ear collects sound waves. The ear canal carries sound waves to the eardrum. Outer Ear Middle Ear Inner Ear Middle ear The semicircular canals help maintain balance. The facial nerve controls muscles in the face. The vestibular nerve carries balance signals to the brain. The auditory nerve carries sound signals to the brain. The eardrum vibrates when it is hit by sound waves. The middle ear bones (ossicles) move when the eardrum vibrates. They transmit sound waves to the inner ear. The eustachian tube helps control air pressure in the middle ear. The cochlea picks up sound waves and produces nerve signals. 4

Middle Ear Problems and Hearing Loss Several conditions can cause hearing changes. These include injury, infection, certain growths, and bone disease.

5 Middle Ear Problems and Hearing Loss Several conditions can cause hearing changes. These include injury, infection, certain growths, and bone disease. Left untreated, some middle ear problems can lead to lifelong hearing loss. There are two types of hearing loss: conductive and sensorineural. One or both kinds can occur. Conductive hearing loss occurs when sound waves do not reach the inner ear. Conductive Hearing Loss Sound waves may be disrupted before they reach the inner ear. If this happens, conductive hearing loss may occur. The ear canal can be blocked by wax, infection, a tumor, or a foreign object. The eardrum can be injured or infected. In the middle ear, abnormal bone growth, infection, or a tumor can block sound waves. Sensorineural hearing loss occurs when sound waves cannot be processed. Sensorineural Hearing Loss Sensorineural hearing loss is also called nerve deafness. It often occurs in both ears. Sound waves may be poorly processed in the inner ear. Or nerve signals may not reach the brain. Aging, loud noise, toxins, or an inherited condition can cause this type of hearing loss. 5

Planning Your Treatment Your treatment options depend on your middle ear problem. If you do choose surgery, you may need more than one procedure. Learn about all your options before you decide.

6 Planning Your Treatment Your treatment options depend on your middle ear problem. If you do choose surgery, you may need more than one procedure. Learn about all your options before you decide. Your Options There may be more than one way to treat your middle ear problem. You and your doctor may discuss any of the following: Medications to control pain and drainage A hearing aid to improve hearing Surgery to relieve symptoms this may be combined with medications or a hearing aid If Surgery Is Right for You Surgery may be the best option for your condition. If this is the case, your doctor can discuss the benefits of surgery with you. He or she will also review surgery s risks and possible complications. Learn what you will need to do to prepare for and recover from surgery. If you have questions, be sure to have them answered. Risks and Complications All surgery has risks. The risks and possible complications of middle ear surgery include: Bleeding Infection Failure of a graft Further hearing loss, distorted hearing, ringing in the ears, or dizziness Facial nerve damage Inner ear damage Increased sensitivity to sound (usually temporary) A change in your sense of taste, or a dry mouth 6

Be sure to do the following: Tell your doctor about all the medications you take. This includes over-thecounter medications, supplements, and herbal remedies.

7 Preparing for Surgery Once surgery has been scheduled, you ll be given instructions on how to prepare. Follow these instructions carefully. You may meet with some or all of the members of your surgical team shortly before surgery. Before Surgery In the weeks or days before surgery, you can help ensure that your surgery goes smoothly. Be sure to do the following: Tell your doctor about all the medications you take. This includes over-thecounter medications, supplements, and herbal remedies. You may need to stop taking some or all of them before surgery. Be sure to mention if you take prescription medications to prevent blood clots or if you take daily aspirin. Take any medications prescribed by your ear specialist, such as antibiotics, as instructed. Stop eating and drinking before surgery as directed. Arrange for an adult family member or friend to drive you home after surgery. On the Day of Surgery At the hospital, an intravenous (IV) line is put in your arm or hand to give you fluids and medications. You will be asked your name and what surgery you are having more than once. This is for your safety. Just before the procedure begins, you will be given anesthesia to prevent pain. Depending on the type, this may make you drowsy and relaxed, lightly asleep, or put you in a state like deep sleep. 7

Tympanoplasty Tympanoplasty is surgery to repair a hole in the eardrum by covering the hole with a patch (graft). Repairing the eardrum can improve hearing. Tympanoplasty also stops ear drainage.

8 Tympanoplasty Tympanoplasty is surgery to repair a hole in the eardrum by covering the hole with a patch (graft). Repairing the eardrum can improve hearing. Tympanoplasty also stops ear drainage. Eardrum Infection and Injury Hole in eardrum The eardrum may have been damaged by chronic ear infections or by an injury. An eardrum with a tear or a hole in it may cause ongoing drainage or interfere with hearing. It may also cause ear pain. Eardrum Eardrum The eardrum is at the end of the ear canal. Repairing the Eardrum Graft The eardrum can be reached through the ear canal or through an incision behind the ear. In either case, the eardrum is lifted up, and a graft is put in place. The graft is a small, thin piece of material. It provides a supportive structure that the eardrum tissue can grow over. 8

Mastoidectomy Mastoidectomy is done to remove growths and infected bone from the middle ear. It may or may not improve your hearing in the affected ear.

Cholesteatoma Middle ear Mastoid air cells Growths and Infection Ossicles The mastoid bone contains small spaces that hold air (air cells).

If not treated, a growth or infection can lead to deafness, facial nerve damage, dizziness, or brain infection. In rare cases, they can cause death.

9 Mastoidectomy Mastoidectomy is done to remove growths and infected bone from the middle ear. It may or may not improve your hearing in the affected ear. It may be done along with a tympanoplasty or an ossicular chain reconstruction. Cholesteatoma Middle ear Mastoid air cells Growths and Infection Ossicles The mastoid bone contains small spaces that hold air (air cells). Skin cells may build up in these air cells and form a growth (cholesteatoma). This growth can destroy nearby bone. Less commonly, the air cells can become infected. If not treated, a growth or infection can lead to deafness, facial nerve damage, dizziness, or brain infection. In rare cases, they can cause death. Mastoid bone You can feel the mastoid bone behind the ear. Ossicles Cholesteatoma and infected mastoid bone removed Removing Mastoid Bone To reach the mastoid bone, the surgeon usually makes an incision behind the ear. Any growths and infected bone are removed from the middle ear and mastoid. 9

10 Ossicular Chain Reconstruction Ossicular chain reconstruction (also called middle ear bone surgery) can improve conductive hearing loss. The ossicular chain is the three bones (ossicles) in the middle ear that help conduct sound to the inner ear. Ossicular chain reconstruction can involve replacing a damaged malleus or incus bone. Or all three middle ear bones may need to be replaced. Malleus Eardrum Damaged Malleus or Incus Bones Damaged incus Healthy stapes Prosthesis Replacing One or Both Bones Stapes Injury or infection can damage the malleus or incus bones. The surgeon reaches these bones by going through the ear canal or making an incision behind the ear. Then an incision is made around the eardrum. The eardrum is lifted up. All or part of the damaged bone is removed. The damaged malleus or incus bone (or both) may be replaced with a part made from your own tissue. Or it may be replaced with a part made from synthetic materials (prosthesis). The surgeon attaches the replacement part where needed. Then the eardrum is put back into place. 10

11 Damaged malleus Eardrum Eardrum Damaged incus Damaged Malleus, Incus, and Stapes Bones Damaged stapes All three middle ear bones may be damaged. The surgeon reaches the bones by going through the ear canal or making an incision behind the ear. Then an incision is made around the eardrum. The eardrum is held to one side. All or part of the damaged bones are removed. Prosthesis Replacing the Bones All three bones may be replaced with a prosthesis. The malleus may be left in place or removed. The surgeon places one end of the prosthesis against the eardrum. The other end may touch the footplate of the stapes bone or be laid against a tissue graft. Then the eardrum is put back into place. Tissue graft 11

12 Stapes Surgery Stapes surgery can improve conductive hearing loss. This surgery is done to replace all or part of a diseased stapes bone. The stapes is the part of the ossicular chain that touches the inner ear. Malleus Incus A Diseased Stapes Bone The stapes bone may be affected by otosclerosis. This disease creates excess bone tissue that limits the motion of the stapes. Then the stapes footplate doesn t vibrate well. As a result, hearing may be lost. Diseased stapes Forceps Crura removed Removing Bone The first step of stapes surgery is removing the arms of the stirrup bone (the crura). The surgeon reaches the stapes by going through the ear canal. The eardrum is lifted up to allow access to the middle ear. The surgeon verifies that the footplate doesn t move as it should. Next, he or she separates the incus from the stapes. Then, the crura are separated from the footplate and removed. 12

Middle ear Drill Malleus Preparing Bone Incus The second step is preparing the footplate for the replacement part. The surgeon may make a hole in the footplate with a laser or drill.

13 Middle ear Drill Malleus Preparing Bone Incus The second step is preparing the footplate for the replacement part. The surgeon may make a hole in the footplate with a laser or drill. This is called a stapedotomy. Or all of the footplate may be replaced. This is called a stapedectomy. A hole may be made in the footplate Prosthesis Replacing Bone Footplate The third step is replacing the crura. A prosthesis is attached to the incus bone. This prosthesis transmits sound waves to the inner ear. The prosthesis stapes can be made of metal, plastic, or both. 13

Recovery After Surgery After surgery, you will be moved to a special area to wake up from anesthesia.

In certain cases, a stay of one or more nights is needed. Right After Surgery You will wake up in the postanesthesia care area (also known as the recovery area).

This may make you feel like your ear is plugged. Going Home Your surgeon will decide when you can leave the hospital.

14 Recovery After Surgery After surgery, you will be moved to a special area to wake up from anesthesia. You will spend some time recovering in the hospital or surgery center. The recovery time for middle ear surgery often varies. You will likely go home the same day. In certain cases, a stay of one or more nights is needed. Right After Surgery You will wake up in the postanesthesia care area (also known as the recovery area). You will be closely watched as the anesthesia wears off. When you are alert, your family can visit you in the recovery area. You may have packing in your ear canal. This may make you feel like your ear is plugged. Going Home Your surgeon will decide when you can leave the hospital. Before you are released, he or she may want to make sure that: You have little or no bleeding. Your pain is controlled. You have no nausea and little or no dizziness. You do not have a fever. After middle ear surgery you will spend some time recovering in the hospital or surgery center. 14

15 Healing at Home When you return home, care for yourself as instructed. You may need to take certain precautions to protect the ear as you heal. Your surgeon will tell you how long to plan to heal at home. Be sure to call the surgeon if you have any questions or concerns during this time. What You Can Do Follow your surgeon s instructions for caring for yourself at home. As you heal, keep the following things in mind: Avoid getting water in the affected ear for as long as directed. You may be told to protect your ear with a cotton ball coated in petroleum jelly when you bathe or shower. Take medications as directed. These may include antibiotics and pain medications. Sneeze or cough with your mouth open to protect your ear. Check with your surgeon before resuming strenuous activity. Avoid heavy lifting or straining for as long as your surgeon directs. Be sure to ask before traveling by airplane or doing other things that change the pressure in your ears. Follow up with your surgeon as directed. He or she will change your ear dressing. You should be able to return to most normal activities soon after surgery. Ask your surgeon what to expect. When to Call Your Surgeon Be sure to call your surgeon if you notice any of the following: After middle ear surgery, avoid getting water in your ear when bathing or showering. Fever of F (38 C) or higher Sudden hearing loss Bleeding from the ear Pain that doesn t respond to medication Ongoing or intense dizziness 15

Also available in Spanish Feeling Good, Hearing Better The goal of your surgery is to reduce your symptoms and improve your quality of life. When you have healed, you may have better hearing.

Doing so will help ensure that you enjoy the benefits of your middle ear surgery. TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.

16 Also available in Spanish Feeling Good, Hearing Better The goal of your surgery is to reduce your symptoms and improve your quality of life. When you have healed, you may have better hearing. Or you may have less drainage from your ear or feel less discomfort. Follow your post-op instructions carefully. Doing so will help ensure that you enjoy the benefits of your middle ear surgery. TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem The StayWell Company, LLC All rights reserved. Made in the USA

Surgery for Conductive Hearing Loss

THE NEW YORK OTOLARYNGOLOGY GROUP, P.C. The Ear, Nose and Throat Specialists Neil M. Sperling, M.D. Otology/Neuro-Otology Diseases of the Ear Facial Nerve Balance Disorders Surgery for Conductive Hearing