Hearing Restoration: Surgical Procedures for Conductive, Sensorineural, and Mixed Hearing Loss

If you are having a difficult time understanding what others are saying, are asking others to repeat themselves, or are finding yourself needing to turn up the television, then you may be suffering from hearing loss. The first step to finding out if hearing restoration surgery will help you is to book a consultation to establish a hearing loss diagnosis. From there, our ENT specialists can help determine if a surgical procedure may help you overcome your hearing loss.

Senior man in need of hearing restoration treatment
Senior patient undergoing hearing restoration treatment

What Is Hearing Restoration Surgery?

Hearing restoration surgery is a treatment for hearing loss that’s performed by otolaryngologists, also known as ENT or Ear, Nose, and Throat doctors. The type of hearing restoration surgery you receive largely depends on whether you have conductive, sensorineural, or mixed hearing loss and how severe the impairment is. Each of these hearing loss categories impacts a different part of the ear and comes with its own unique set of symptoms and surgical options.

The Three Types of Hearing Loss That Hearing Restoration Aims to Heal

Conductive Hearing Loss

Conductive hearing loss is the most common type of hearing impairment and is caused by an obstruction or damage to the outer or middle ear that prevents sound from reaching your cochlea, the hearing part of the inner ear. Blockage in your ear canal, fluid between your eardrum and cochlea, a perforated eardrum, or problems with the tiny bones in the middle ear may all cause hearing loss. This type of hearing loss can often be corrected with surgery that repairs the ear canal, eardrum, or bones in the middle ear.

Sensorineural Hearing Loss

Sensorineural hearing loss is caused by damage to the inner ear or auditory nerve and is the second most common type of hearing loss. In the inner ear there are tiny hair cells that convert soundwaves into electrical pulses which are sent to the brain through the auditory nerve. When these hair cells are damaged by loud noise, disease, trauma, infection, or aging you may get hearing loss. If severe enough, this type of hearing loss can often be corrected with a cochlear implant, which bypasses the damaged inner ear and sends sound directly to the auditory nerve.

Mixed Hearing Loss

Mixed hearing loss is a combination of conductive and sensorineural hearing loss and may be corrected with a combination of surgical procedures that target both the inner and outer ear.

Senior woman in need of hearing restoration treatment
Senior woman undergoing hearing restoration treatment

Surgeries Available for Conductive and Sensorineural Hearing Loss

There are several different surgeries available to treat conductive and sensorineural hearing loss.

Conductive Hearing Loss

1. Pressure Equalization (PE) Tube Surgery: this surgical treatment is performed in children and adults who experience recurrent ear infections or fluid buildup in the middle ear. A small tube is placed through the eardrum and a small tube is placed through to help equalize the pressure, drain any fluid buildup, and relieve the pain and inflammation within the middle ear. This may help restore hearing loss that has been attributed to abnormal eardrums or Eustachian tubes.

2. Stapedectomy: this surgery treats individuals who have otosclerosis, which is when the smallest bone in the ear, called the stapes, becomes fixed due to abnormal bone growth around it. The role of the stapes is to translate sound waves from the outer ear to the cochlea. When it cannot vibrate, you get conductive hearing loss. To fix this a stapedectomy will either partially or totally remove the stapes bone to allow soundwaves pass through to the inner ear unimpeded which can significantly improve sound conduction and hearing.

3. Canalplasty: if the external auditory canal (EAC) is narrow, either from congenital or acquired means, a canalplasty can be done to widen it. If the narrowed external auditory canal leads to trapped debris, chronic infections, or hearing loss due to occlusion, then a canalplasty is recommended. Other primary reasons for this type of surgery are to remove bony or soft tissue growths or scarring within the external auditory canal.

4. Tympanoplasty: if the eardrum becomes perforated (infection or trauma), this reduces its ability to vibrate the middle ear hearing bones, causing hearing loss. A tympanoplasty repairs the perforation using graft material such as soft tissue (muscle or cartilage). The incision is made either behind the eardrum or the ENT surgeon goes through the ear canal.

5. Ossicular Reconstruction: if the middle ear hearing bones are absent or become destroyed (congenital or from chronic infection), an ossicular reconstruction can be performed through the ear canal to replace the middle ear bones with a prosthesis made of titanium.

6. Bone Anchored Hearing Aid: in those with profound conductive hearing loss, where a traditional hearing aid would be of no use, a bone anchored hearing aid is an alternative treatment. In this system, an implant is surgically inserted into the bone behind the ear, and a hearing aid is placed over top. When sound is detected, the vibrations are sent to the inner ear through the bone.

Hearing restoration session

Sensorineural Hearing Loss

1. Cochlear Implants: the cochlear implant is a surgical treatment option for individuals with profound deafness or are hard-of-hearing. It can help restore hearing and speech understanding, and is made up of two components, an implant and an external component. The implant is surgically placed under the skin behind the ear and connects to electrodes that are inserted into the cochlea. The external component is made up of a microphone, speech processor, and battery, which captures sounds and translates them into electrical signals. These signals get transmitted through the skin to the implant, which sends the signals to the electrodes in the cochlea.

2. Implantable Hearing Aids: for individuals with mild to moderate sensorineural hearing loss, an implantable hearing aid may be a great alternative option. It is placed deep near the eardrum, deep within the ear canal to help the individual enhance their hearing. This type of hearing aid is different from traditional hearing aids, as it must be replaced 6-8 times per year, and doesn’t work on profound hearing loss.

If you are experiencing hearing loss, getting a consultation with an ENT will help determine what type of hearing loss you have and what the right surgical treatment route is for you.

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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.