Surgery for Chronic Ear Disorders

Our ears are our connection to the world around us. While their primary function is to allow us to hear our environment, our ears also allow us to maintain our balance. Complicated ear disorders are extremely debilitating, and without the proper diagnosis and treatment, they can lead to pain, balance complications, and hearing loss. This is why Florida Otolaryngology Group offers a variety of surgical treatment options for chronic ear disorders, and works with you to find the best treatment option for your specific condition.

What Are Chronic Ear Disorders?

A chronic ear disorder refers to any ear disorder or condition that affects the ear longer than three months. Chronic ear disorders are often associated with symptoms like vertigo, hearing loss, pain in the ears, tinnitus, drainage, and ear infections.

What Are Chronic Ear Disorders?
Types of Surgical Treatment Available for Chronic Ear Disorders

Types of Surgical Treatment Available for Chronic Ear Disorders

The type of surgical treatment you receive will depend on the specific chronic ear disorder. Some of the most common surgical treatments for chronic ear disorders include:

1. Ossiculoplasty: this type of ear surgery is used to reconstruct the ossicles (malleus, incus, and stapes) bones. These bones are the three smallest in the human body and are responsible for amplifying and conducting outside sound waves to the inner ear. Chronic ear infections, trauma, or tumors can cause damage to these bones, resulting in conductive hearing loss. The ossiculoplasty ear surgery repairs this chain of bones either by reshaping and repositioning them to reestablish contact, or a synthetic prosthesis may be used. This type of surgery can help treat chronic ear disorders like cholesteatoma or chronic otitis media.

2. Stapedectomy: this chronic ear surgery is performed to remove the stapes bone to treat hearing loss that is a result of otosclerosis, a condition in which the stapes (one of the small bones in the middle ear) becomes fixed and unable to vibrate. The stapes is removed with a stapedectomy and is replaced with a microprosthesis.

3. Tympanoplasty: this surgery is performed to repair the eardrum. This is an outpatient procedure and is performed usually through the ear canal. The eardrum is repaired with a fascia tissue graft or with cartilage. This type of surgery may help reverse hearing loss associated with infection.

4. Myringoplasty: this is a surgery that is used to repair a hole in the eardrum. The eardrum can become perforated due to chronic ear infections (otitis media), from air pressure trauma (barotrauma), from acoustic trauma (loud sounds), from foreign objects being pushed into the ear (cotton swabs), or from severe head trauma. In rare cases, if the perforated eardrum remains unhealed, a cholesteatoma can form, which is a cyst composed of skin cells and ear canal debris. During this surgery, the eardrum is repaired with tissue graft, which helps improve hearing and prevents infection from entering the ear.

5. Myringotomy: this is a type of surgery that creates a small hole in the eardrum to allow fluid that is trapped within the middle ear room to drain and to allow ventilation of the middle ear. By making a small incision in the eardrum, the pressure within the middle ear is relieved, as the excess buildup of fluid or pus can drain out. This type of surgery is often recommended as treatment for otitis media and chronic otitis externa.

6. Mastoidectomy: this type of surgery is used to remove tissue growth, diseased tissue lining, infected bone, and infection that sits in the bone behind the middle ear. It is commonly used to treat chronic ear infections, mastoiditis (an infection of the bony air cells in the mastoid bone), and cholesteatoma (a skin-lined cyst that begins by the eardrum and invades the middle ear).

Myringoplasty for Chronic Ear Disorders
Meatoplasty for Chronic Ear Disorders

7. Meatoplasty: This is when the cartilage from the outer opening of the ear canal is removed to enlarge the opening of the external ear canal.

8. Eustachian Tube Surgery: this surgery is used to treat dysfunction of the Eustachian tube. This Eustachian tube runs from the middle ear through to the back of the nose. Its primary role is to equalize the pressure on either side of the eardrum. When it’s blocked, fluid can build up in the middle ear, causing pain and pressure. Eustachian tube surgery can help to open the blocked tube and restore normal function.

Tumor Removal: in some cases, a tumor may be the cause of chronic ear disorder. Tumor removal surgery is used to remove the tumor and restore normal function to the ear. Examples of tumorous growths include acoustic neuromas, cholesteatoma (cyst), and glomus tympanicum (middle ear).

If you’ve been living with a chronic ear disorder, there’s no need to suffer any longer. Contact our team at Florida Otolaryngology Group today to schedule an appointment and learn more about the surgical treatment options available to you. Our team is happy to answer any questions you have and are ready to help you hear again.

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Our practice is uniquely qualified and capable of providing unparalleled treatment for the full range of Ear, Nose, & Throat and Head & Neck problems.

Brittany Dobson MD Ear Nose Throat Doctor

Painful ear infections are a rite of passage for children—by the age of five, nearly every child has experienced at least one episode. Most ear infections either resolve on their own (viral) or are effectively treated by antibiotics (bacterial). But sometimes, ear infections and/or fluid in the middle ear may become a chronic problem leading to other issues such as hearing loss, behavior and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose and throat specialist) may be considered.

Ear tubes are tiny cylinders placed through the ear drum (tympanic membrane) to allow air into the middle ear. They also may be called tympanostomy tubes, myringotomy tubes, ventilation tubes, or PE (pressure equalization) tubes. These tubes can be made out of plastic, metal or Teflon and may have a coating intended to reduce the possibility of infection. There are two basic types of ear tubes: short-term and long-term. Short- term tubes are smaller and typically stay in place for six months to a year before falling out on their own. Long-term tubes are larger and have flanges that secure them in place for a longer period of time. Long-term tubes may fall out on their own, but removal by an otolaryngologist is often necessary.

Ear tubes are often recommended when a person experiences repeated middle ear infection (acute otitis media) or has hearing loss caused by the persistent presence of middle ear fluid (otitis media with effusion). These conditions most commonly occur in children, but can also be present in teens and adults and can lead to speech and balance problems, hearing loss, or changes in the structure of the ear drum. Other less common conditions that may warrant the placement of ear tubes are malformation of the ear drum or eustachian tube, Down Syndrome, cleft palate and barotrauma (injury to the middle ear caused by a reduction of air pressure, usually seen with altitude changes such as flying and scuba diving).

Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (a hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel (tiny knife), but it can also be accomplished with a laser. If an ear tube is not inserted, the hole would heal and close within a few days. To prevent this, an ear tube is placed in the hole to keep it open and allow air to reach the middle ear space (ventilation).

Each year, more than half a million ear tube surgeries are performed on children, making it the most common childhood surgery performed with anesthesia. The average age for ear tube insertion is one to three years old.

Inserting ear tubes may:

  • Reduce the risk of future ear infection
  • Restore hearing loss caused by middle ear fluid
  • Improve speech problems and balance problems
  • Improve behavior and sleep problems caused by chronic ear infections

A light general anesthetic (laughing gas) is administered for young children. Some older children and adults may be able to tolerate the procedure without anesthetic. A myringotomy is performed and the fluid behind the ear drum (in the middle ear space) is suctioned out. The ear tube is then placed in the hole. Ear drops may be administered after the ear tube is placed and may be necessary for a few days. The procedure usually lasts less than 15 minutes and patients awaken quickly.

Sometimes the otolaryngologist will recommend removal of the adenoid tissue (lymph tissue located in the upper airway behind the nose) when ear tubes are placed. This is often considered when a repeat tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infection and the need for repeat surgery.

After surgery, the patient is monitored in the recovery room and will usually go home within an hour if no complications occur. Patients usually experience little or no postoperative pain but grogginess, irritability, and/or nausea from the anesthesia can occur temporarily.

Hearing loss caused by the presence of middle ear fluid is immediately resolved by surgery. Sometimes children can hear so much better that they complain that normal sounds seem too loud.

The otolaryngologist will provide specific postoperative instructions, including when to seek immediate attention and to set follow-up appointments. He or she may also prescribe antibiotic ear drops for a few days.

To avoid the possibility of bacteria entering the middle ear through the ventilation tube, physicians may recommend keeping ears dry by using ear plugs or other water-tight devices during bathing, swimming and water activities. However, recent research suggests that protecting the ear may not be necessary, except when diving or engaging in water activities in unclean water such as lakes and rivers. Parents should consult with the treating physician about ear protection after surgery.

Consultation with an otolaryngologist (ear, nose and throat specialist) may be warranted if you or your child has experienced repeated or severe ear infections, ear infections that are not resolved with antibiotics, hearing loss due to fluid in the middle ear, barotrauma, or have an anatomic abnormality that inhibits drainage of the middle ear.

Myringotomy with insertion of ear tubes is an extremely common and safe procedure with minimal complications. When complications do occur, they may include:

  • Perforation—This can happen when a tube comes out or a long-term tube is removed and the hole in the tympanic membrane (ear drum) does not close. The hole can be patched through a minor surgical procedure called a tympanoplasty or myringoplasty.
  • Scarring—Any irritation of the ear drum (recurrent ear infections), including repeated insertion of ear tubes, can cause scarring called tympanosclerosis or myringosclerosis. In most cases, this causes no problem with hearing.
  • Infection—Ear infections can still occur in the middle ear or around the ear tube. However, these infections are usually less frequent, result in less hearing loss and are easier to treat—often only with ear drops. Sometimes an oral antibiotic is still needed.
  • Ear tubes come out too early or stay in too long—If an ear tube expels from the ear drum too soon (which is unpredictable), fluid may return and repeat surgery may be needed. Ear tubes that remain too long may result in perforation or may require removal by an otolaryngologist.