Surgery for Hearing Loss Reconstruction

Hearing loss reconstruction usually becomes an option when there is a clear deformity or abnormality of some part of the ear that’s affecting the ability to hear. In many cases, non-surgical attempts to correct hearing loss are made before considering surgery.

• Patients who undergo hearing loss reconstruction may experience the full restoration of hearing
• Patients may also reach a point where hearing improves enough to have a positive impact on quality of life

Sound waves go to the ear canal and cause the eardrum (tympanic membrane) to vibrate. Three bones in the middle ear (hammer, anvil, and stirrup) transmit vibrations to the inner (cochlea), which is filled with fluid. Inner ear movements cause waves in the fluid, in turn stimulating hair cells that activate auditory nerves and send signals to the brain. Any disruption in this process may result in some degree of hearing loss. For some people, the reason for a loss of hearing is because of issues with structures in the ear that are either damaged or deformed. This is one of several reasons why surgical hearing loss reconstruction may be necessary to restore hearing capabilities.

When an obstruction or deformity of the external ear canal is responsible for hearing loss, canalplasty may be performed. The procedure can involve widening the ear canal, removal of the obstruction, or creation of a new ear canal. Canalplasty is also sometimes performed on patients who may have hearing issues due to an ear canal that’s either not closed or absent altogether (aural atresia). A CT scan is done to determine if the anatomy of the affected ear will allow for surgical correction of the problem.

A eardrum that’s damaged will have an effect on the ability to hear. If a perforated eardrum does not heal on its own or if the damage is severe, the eardrum may be repaired with tympanoplasty. Graft material from cartilage or muscle is used to reconstruct and restore the normal appearance and function of the eardrum.

Hearing loss from otosclerosis results from abnormal growth of a bone near the middle ear. Specifically, it’s a hardening of the base of a very small bone called the stapes. After a positive diagnosis is made with image tests to rule out other potential sources of hearing loss, a stapedectomy may be performed if other treatment options aren’t effective. During the procedure, which has a success rate of more than 90 percent, a laser is used to connect two of the middle ear bones to the inner ear.

Patients with a rare congenital condition called microtia, an external ear deformity, sometimes have related inner ear deficiencies (atresia) that can affect hearing. Rib cartilage reconstruction is the standard surgical procedure performed to restore the normal appearance of the external ear.

Some patients have tumors in or around the ear located in places that cannot be safely reached without removing parts of the ear. The extent of the reconstruction needed will depend on what was removed. After a translabyrinthine is performed to remove a benign acoustic neuroma, for example, reconstruction surgery usually involves a bone behind the ear and parts of the middle ear. If extensive tumor excision (removal) requires multiple ear structures to be removed, surgery typically involves restoring the appearance and function of several parts of the ear. In situations like this, multiple surgeries may be necessary to achieve the desired results. Even then, hearing not be fully restored for some patients, although hearing aids may help.

Hearing loss may be due to a disruption of the sound conduction system in the middle ear. The three bones that are part of this system (ossicles) sometimes become damaged from trauma, surgery performed to treat another ear problem, or repeated ear infections. A hearing test and examination of the ear can determine if this is the reason for a patient’s hearing loss. During an outpatient procedure known as an ossicular chain reconstruction, the non-functioning middle ear bone is removed and replaced with an artificial implant.

Patients with severe-to-profound sensorineural (from damage to inner ear hair cells) or conductive (from a disruption of sound waves inside the ear) hearing loss may benefit from surgically attached or implanted devices to correct issues with how sound is processed within the ear. Options include a bone anchored hearing aid placed in a bone behind the ear or a cochlear implant.

If surgery does not fully restore the ability to hear, a hearing aid may be recommended to improve the perception of certain sounds, tones, and pitches.