tympanoplasty | The New York Otolaryngology Group

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Is there any treatment for tympanosclerosis other than surgery?

Question:

Hello,
Is there any treatment for Tympanosclerosis other than surgery? Is there any new and recent techniques for Tympanoplasty (like laser or other) that are more practical and easier? What about success rates and possibilities of hearing loss restoration? And what about potential approximate costs for such surgery?
Thank you in advance.

Answer:

Tympanosclerosis is an invasive form of scar tissue that follows infection(s) in the ear.  At times it can cause significant hearing loss.  Although not universal, many cases can be repaired surgically and hearing restored using modern Tympanoplasty techniques possibly with the use of a laser.

If you would like further evaluation and consideration of your case, please come in for an evaluation.
Best of luck!

Neil Sperling, MD

Associate Professor, Dept of Otolaryngology
SUNY Downstate
Brooklyn, New York

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Ear Tube Surgery

Insight into causes and treatment options

  • Who needs ear tubes and why?
  • What to expect after surgery
  • and more…

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, or behavior and speech problems. In these cases, insertion of an ear tube by an otolaryngologist (ear, nose, and throat specialist) may be considered.

What are ear tubes?

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 tubesventilation tubes
  • PE (pressure equalization) tubes

These tubes can be made out of various materials 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 may be necessary.

Who needs ear tubes and why?

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 as in flying and scuba diving).

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; and
  • Improve behavior and sleep problems caused by chronic ear infections.

How are ear tubes inserted in the ear?

Ear tubes are inserted through an outpatient surgical procedure called a myringotomy. A myringotomy refers to an incision (small hole) in the ear drum or tympanic membrane. This is most often done under a surgical microscope with a small scalpel, 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).

What happens during surgery?

A general anesthetic 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 prescribed 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 second or third tube insertion is necessary. Current research indicates that removing adenoid tissue concurrent with placement of ear tubes can reduce the risk of recurrent ear infections and the need for repeat surgery.

What happens after surgery?

After surgery, the patient is monitored in the recovery room and will usually go home within an hour or two 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..

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. An audiogram should be performed after surgery, if hearing loss is present before the tubes are placed.  This test will make sure that hearing has improved with the surgery.

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. 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.

Possible complications

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 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.
If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Ear Surgery

Sometimes surgery is the best way to restore health and hearing, and you can be confident that at NYOG you are in the hands of the best surgeons in the field.

Our success rates with surgical interventions are among the highest in the country. Our doctors are consistently ranked as the finest physicians available by Castle Connolly, New York Magazine’s Best Doctors, Best Doctors in America (a rating by peer physicians), Super Doctors, and New York’s Top Doctors.

As always, we are here to answer any and all of your questions regarding your ear and hearing health and all options for your treatment. Below are some descriptions of the surgeries associated with the ear and hearing. We want our patients to be as informed as possible, because at NYOG our goal is to…clear things up.

Types of ear surgery include:

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Perforated Eardrum

Insight into ear injuries

  • What is a perforated eardrum?
  • What causes eardrum perforation?
  • How is hearing affected by a perforated eardrum?
  • and more…

A hole or rupture in the eardrum, a thin membrane that separates the ear canal and the middle ear, is called a perforated eardrum. The medical term for eardrum is tympanic membrane. The middle ear is connected to the nose by the eustachian tube, which equalizes pressure in the middle ear.

A perforated eardrum is often accompanied by decreased hearing and occasional discharge. Pain is usually not persistent.

What causes eardrum perforation?

The causes of a perforated eardrum are usually from trauma or infection. A perforated eardrum from trauma can occur:

  • If the ear is struck directly
  • With a skull fracture
  • After a sudden explosion
  • If an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal
  • As a result of acid or hot slag (from welding) entering the ear canal

Middle ear infections may cause pain, hearing loss, and spontaneous rupture (tear) of the eardrum, resulting in a perforation. In this circumstance, there maybe infected or bloody drainage from the ear. In medical terms, this is called otitis media with perforation. Symptoms of acute otitis media include a sense of fullness in the ear, diminished hearing, pain, and fever.

On rare occasions a small hole may remain in the eardrum after a previously placed pressure-equalizing (PE) tube falls out or is removed by the physician.

Most eardrum perforations heal on their own within weeks of rupture, although some may take several months to heal. During the healing process the ear must be protected from water and trauma. Eardrum perforations that do not heal on their own may require surgery.

How is hearing affected by a perforated eardrum?

Usually the size of the perforation determines the level of hearing loss – a larger hole will cause greater hearing loss than a smaller hole. The location of the perforation also affects the degree of hearing loss. If severe trauma (e.g., skull fracture) dislocates the bones in the middle ear which transmit sound, or injures the inner ear structures, hearing loss may be severe.

If the perforated eardrum is caused by a sudden traumatic or explosive event, the loss of hearing can be great and tinnitus (ringing in the ear) may be severe. In this case, hearing usually returns partially, and the ringing diminishes in a few days. Chronic infection as a result of the perforation can cause persistent or progressive hearing loss.

How is a perforated eardrum treated?

Before attempting any correction of the perforation, a hearing test should be performed. The benefits of closing a perforation include prevention of water entering the ear while showering, bathing, or swimming (which could cause ear infection), improved hearing, and diminished tinnitus. It also may prevent the development of cholesteatoma (skin cyst in the middle ear), which can cause chronic infection and destruction of ear structures.

If the perforation is very small, an otolaryngologist may choose to observe the perforation over time to see if it will close spontaneously. He or she might try to patch a patient’s eardrum in the office. Working with a microscope, your doctor may touch the edges of the eardrum with a chemical to stimulate growth and then place a thin paper patch on the eardrum. Usually with closure of the tympanic membrane, hearing is improved. Several applications of a patch (up to three or four) may be required before the perforation closes completely. If your physician feels that a paper patch will not provide prompt or adequate closure of the hole in the eardrum, or if paper patching does not help, surgery may be required.

There are a variety of surgical techniques, but most involve grafting skin tissue across the perforation to allow healing. The name of this procedure is called tympanoplasty. Surgery is typically quite successful in repairing the perforation, restoring or improving hearing, and is often done on an outpatient basis.

Your doctor will advise you regarding the proper management of a perforated eardrum.

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Ear Drum Perforations

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The ear drum (also known as the tympanic membrane) is the thin layer of skin that covers the deeper air-containing space called the middle ear. It is a barrier to external objects entering the ear.  It serves to ‘focus’ the sound energy to the Ossicular chain.  This is a chain of 3 bones that conduct the sound energy through the middle ear to the inner ear where the nerve endings are located.  The 3 bones are (in order from external to internal):  Malleus, Incus and Stapes.

An opening or perforation in the tympanic membrane can result in hearing loss by interfering with the normal transfer of sound to the ossicular chain. Perforations typically occur from injury or repeated infections. At times the ossicular bones may be damaged or dislocated causing a disruption of sound energy transmission and thus a conductive hearing loss.

By repairing the tympanic membrane and/or the ossicular bones, the normal conductive mechanism can be re-established and hearing loss improved.

Surgery for Perforation: Tympanoplasty

Surgery to repair the ear drum is termed Tympanoplasty and may or may not include repair of the ossicles (ossicular chain reconstruction).  This surgery typically requires a graft of your own tissues. This ‘patch’ is usually taken from behind the ear leaving a small scar.

Download: Surgery for Hearing Restoration, by Dr. Neil Sperling

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Cholesteatoma

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Cholesteatoma is a benign growth caused by the build-up of skin cells and protein from the ear canal behind the eardrum.

The outer ear is lined with a layer of skin that casts off dead cells containing keratin, a protein. This discharge, a component of earwax, occurs normally and is removed when the ears are routinely cleaned.

If, however, a bit of this skin penetrates the eardrum — which can occur for a number of reasons — the keratin that continues to be given off by the skin becomes trapped in the middle ear and builds-up over time, resulting in a cholesteatoma. If left untreated, the growth can erode the ossicles (the tiny hearing bones of the middle ear) and cause a conductive hearing loss. It can further fill the mastoid and destroy structures of the inner ear, causing permanent, sensorineural hearing loss. Unchecked, this tumor-like growth has the potential to cause facial paralysis, hydrocephalus, meningitis, or a brain abscess.

SYMPTOMS

Although some patients have very mild or no symptoms of cholesteatoma, the most common sign of the condition is frequent ear infections, possibly with a foul smelling discharge from the ear. Coincident loss of hearing is often present.

DIAGNOSIS

The diagnosis of cholesteatoma is primarily made by microscopic examination of the ear during an office visit. An audiogram, or hearing test, is important to determine if the hearing has been damaged and a CT scan of the temporal bone (the bone containing the inner part of the ear) is required to determine the extent to which the cholesteatoma has spread.

TREATMENT

The primary goal of treatment is to control the infection and bone destruction caused by a growing cholesteatoma; restoring the ability to hear is a secondary objective. If the cholesteatoma is small and hearing loss remains at acceptable levels, then microscopic cleaning may be performed during an office visit to clean the keratin out of the ear.

For a more advanced cholesteatoma, a mastoidectomy may be performed. Depending on the unique circumstances, a patient might also receive a tympanoplasty and ossicular (hearing) reconstruction. Mastoidectomy is a surgical procedure designed to remove cholesteatoma and infections from within the mastoid bone, which protects the structures of the middle and inner ear. Tympanoplasty is the surgical reconstruction of the eardrum and hearing apparatus. Ossicular reconstruction may be necessary if the infection has eroded the bones of the middle ear. The damaged bones are replaced by bone or a prosthesis, which restores the proper function of the middle ear.

As cholesteatomas can recur, close post-surgical follow-up is very important. Additional surgery is sometimes required to achieve complete removal.