Middle Ear Surgery
The ear is made up of the basic parts: the outer ear, the middle ear, and the inner ear. The middle ear is an air-filled cavity which consists of an eardrum and three tiny, interconnected bones called the hammer, anvil, and stirrup. Middle ear surgery is used to treat a variety of conditions in any of these parts.
Most ear surgery is microsurgical, performed using an operating microscope to enable the surgeon to view the very small structures of the ear. Types of middle ear surgery include: a stapedectomy to repair hearing loss by replacing a middle ear bone with a prosthesis, a tympanoplasty to repair or reconstruct the eardrum after perforation, a myringotomy to drain ear fluid, preventing infection and normalizing middle ear pressure, and surgery to remove a middle ear tumor.
Minimally invasive laser surgery for middle ear procedures is increasing in popularity. Laser surgery reduces trauma,reduces the risk of excessive bleeding and allows the surgeon to operate more easily on hard to reach places in the middle ear.
Tympanoplasty is a surgical procedure performed to reconstruct the eardrum when it has been badly torn or perforated. There are several reasons a tympanoplasty may need to be performed, including congenital deafness and injury to the tympanic membrane due to: serious or chronic middle ear infections, accidents, or extreme changes in air pressure.
Whenever there are symptoms of pain, discharge or bleeding from the ear, or hearing loss, a doctor should be consulted since these symptoms may be the result of eardrum perforation. Eardrum perforation is diagnosed by an examination of the ear using an instrument known as an otoscope. A hearing test is also often performed to evaluate whether the patient has sustained any hearing loss. Minor eardrum perforations may not require treatment since they will heal on their own. When the injury does not heal in a few weeks, a tympanoplasty is usually necessary.
During tympanoplasty the surgeon makes a cut either behind the ear or inside the ear canal. When the eardrum is perforated, there may be fractures of the small bones of the inner ear, called ossicles, as well. This happens frequently in children as a result of ear infections. When this occurs, the bones involved must be removed, repaired or replaced. If there is only a small hole in the eardrum, the doctor may be able to perform a lesser procedure, called a myringoplasty
A tympanoplasty procedure is usually performed outpatient, meaning patients are able to return home later the same day.
While tympanoplasty is considered a safe and effective procedure, there are risks associated with any type of surgical procedure. Risks of a tympanoplasty may include: excessive bleeding, infection, breathing problems, adverse reaction to anesthesia, hearing loss and facial nerve injury. These complications are considered rare and are minimized by having an experienced and skilled surgeon perform the procedure. The symptoms experienced before the surgical procedure, such as hearing loss, usually abate quickly after the tympanoplasty procedure. During the period immediately following a tympanoplasty, patients should refrain from swimming, air travel and crowds.
A myringotomy is a surgical procedure in which a small incision is made in the tympanic membrane (eardrum) to remove fluid such as blood, pus or water from the middle ear.
A myringotomy is performed to relieve pressure buildup in the middle ear, usually due to chronic middle ear infections which are resistant to other treatments. There may also be excessive fluid present due to severe allergies.
Reasons for a Myringotomy
When adults require this operation it is usually as a result of barotrauma, or sudden change in ear pressure, which may be caused by scuba-diving, air travel, mountain climbing or explosion. Adults may also require a myringotomy when they develop mastoiditis, an infection of the bone behind the ear, that has spread, or is in danger of spreading.
Most doctors do not suggest a myringotomy for children's ear infections unless:
- There are recurrent ear infections in a short period of time
- Fluid buildup persists for over 6 months in one ear
- Fluid buildup persists for over 3 months in both ears
- Hearing is badly affected
- There is a speech delay
- It is necessary to remove fluid for laboratory examination
A myringotomy is nearly always successful and provides immediate relief from symptoms. Most children on whom this procedure is performed do not suffer any hearing loss or speech delays.
Risks of a Myringotomy
While a myringotomy is considered an extremely safe procedure, there are risks involved in any type of surgery. Risks of surgery in general may include:
- Excessive bleeding
- Breathing difficulties
- Adverse reactions to anesthesia or medications
Risks of a myringotomy in particular may include continuing drainage from the ear or a hole in the eardrum that does not heal. In the case of the latter, the eardrum will need to be surgically repaired.