Hearing Loss Surgical Options

One of the most important senses a person has is hearing. Hearing helps a person experience the differences in the tone and meaning of a speech pattern. There are a number of reasons why people have trouble hearing. They might have been born with a hearing problem or even a complete loss of hearing.  There are also instances where prolonged exposure to loud noises can cause a person to lose a good portion of their hearing.

While some ear surgeries are done for aesthetic reasons, aka otoplasty, to correct the look of ears that are damaged or misshaped, other ear surgeries are microsurgical and done to correct hearing loss. These surgeries are performed using a microscope that lets the surgeon view the smaller structures in the ear. Once the reason for hearing loss has been determined, there are a number of surgeries available to correct hearing loss.

Surgical Procedures for Treating Hearing Loss

A surgeon can take various approaches to access the parts of the ear where the surgery will be performed. An operation that is performed via the ear canal without an incision needing to be done around the ear is called a transmeatal approach. If an incision is required around the ear so the surgeon can have better access to the area that needs to be operated on, such as the inner or middle ear, the incision can be made right in front of the ear. This is known as an endaural incision. 

No matter what the cause is for hearing troubles, there are a variety of surgeries to help restore some or all of a person’s ability to hear. Some of the surgical options include:

• The surgery to repair a hole in the eardrum is called tympanoplasty. It is performed on an outpatient basis and the patient is given general anesthesia. An incision is made behind the patient’s ear and a graft is placed under the remnant of the eardrum.
• Stapedectomy is performed to help with hearing loss caused by calcium around the stirrup. This hearing loss condition is known as otosclerosis. Stapedectomy basically involves the removal of the stirrup through the use of a laser then replacing it with a small metal piston. There are three types of otosclerosis:

1. Stapedial otosclerosis is when otosclerosis spreads to the stapes bone (also known as the stirrup) and prevents it from vibrating which causes conductive hearing loss.
2. Cochlear otosclerosis is when otosclerosis invades the cochlea and causes permanent damage to the sensory hair cells or to the nerve pathways that connect the inner ear to the brain. This type of otosclerosis causes sensorieural hearing loss so stapedectomy is not an option.
3. Mixed otosclerosis is a combination of both of the above conditions and it often occurs as the disease progresses.

• People suffering from greater hearing loss in both of their ears might need more help than can be provided by hearing aids. Cochlear implants involve an incision being made behind the ear. After the incision is made, the implant is placed in a depression in the skull. Electrodes go through the middle ear into the implant in the inner ear.
• When the eardrum is perforated due to chronic infection, the solution is mastoid tympanoplasty. The ear canal has to be enlarged so the mastoid air cells can be removed while the eardrum is repaired.
• The ear has three basic parts which are the outer, inner and middle ear. In fact, the middle ear is actually a cavity filled with air and it has an eardrum as well as three tiny bones called the anvil, stirrup and hammer. One middle ear surgery procedure is myringotomy. This middle ear surgery works to prevent any further infections as well as stabilize any pressure in the middle ear and drain ear fluid. Middle ear surgery can also be necessary to remove tumors in some cases.
• Some surgeons are able to perform minimally invasive laser surgery on the middle ear. Laser surgery allows the surgeon the opportunity to reach sections of the middle ear, reduce blood clotting and also reduce the amount of trauma to (and in) the middle ear.

Tests to Diagnose Hearing Loss

There are several tests that can be used to diagnose hearing loss:

Physical exam - This entails the surgeon looking in the ear for possible causes of hearing loss such as ear wax or inflammation from an infection. The surgeon will also look out for structural defects that could be the source of the hearing problems.

General screening tests - These are a variety of tests carried out to determine hearing ability. The surgeon may use the whisper test. This involves patients covering one ear at a time to see how well they hear words spoken at various volumes and how they respond to other sounds. It should be noted that the accuracy of this test can be limited.

App-based hearing tests - The development of science and technology has improved and made a lot of things easier. Patients can now make use of mobile apps on their phone or tablet to screen for moderate hearing loss.

Tuning fork tests - A tuning fork test is an important test used in the diagnosis of hearing loss. The test also serves other functions besides determining hearing ability. Tuning forks are two-pronged metal instruments that produce sounds when struck. Simple tests with tuning forks can help a doctor detect hearing loss. This evaluation may also reveal where the damage has occurred in the ear.

Audiometer tests - This is arguably the most efficient way to test for hearing loss. Patients wear earphones and hear sounds and words directed to each ear. Each tone is repeated at faint levels to find the quietest sound they can hear.

Consult with a Board-Certified Hearing Specialist

The ability to hear is one of the greatest senses a person can have in life. Hearing allows people to enjoy a conversation with family and friends as well as enjoy the simple sounds of nature. Any gradual loss of hearing should be treated with as much caution and care as a complete loss of hearing. Making an appointment with an experienced and knowledgeable doctor is a vital first step in the treatment of hearing loss. Once a patient undergoes a thorough examination, the doctor can make a recommendation about a treatment plan as well as start the patient on the road to a partial or complete recovery.

- MA