Advanced Surgical Treatments for Hearing Loss -- March 10, 2008 -- Dr. David Haynes & Dr. Marc Bennett - | Nashville News, Weather & Sports

Advanced Surgical Treatments for Hearing Loss -- March 10, 2008 -- Dr. David Haynes & Dr. Marc Bennett


Advanced Surgical Treatments for Hearing Loss

Medical Mondays
David Haynes, MD, otological surgeon
Marc Bennett, MD,  otological surgeon
March 10, 2008


Hearing Loss

There are two main types of hearing loss: sensorineural and conductive.

Sensorineural hearing loss, also known as "nerve deafness," causes 95% of all hearing problems. The remaining 5 percent of hearing problems are due to conductive hearing loss. In these conditions, sound is not transferred from the outer to the inner ear. Conductive hearing loss can result from chronic otitis media with or without cholesteatoma, trauma, congenital defect, otosclerosis. In otosclerosis, a form of conductive hearing loss, the tiny bones of the inner ear become stiffened and no longer transmit sound properly. Surgery can help some people with otosclerosis.

Chronic Otitis Media

Otitis media is an inflammation and/or infection of the middle ear. Chronic means recurring or persistent. Alternative names :middle ear infection - chronic; Ear infection - chronic; Chronic otitis media; Chronic ear infection

Causes/ Incidence/Risk Factors

Inflammation or infection of the middle ear occurs when the eustachian tube to that ear is blocked. The eustachian tube is the passage from the back of the throat to the middle ear. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly (or remains blocked for long periods) due to allergies (particularly worse in Tennessee), multiple infections, ear trauma, smoking or swelling of the adenoids.

When the middle ear is actually infected with bacteria (or occasionally, viruses) rather than just inflamed, it is more serious. A chronic ear infection may be the result of an acute ear infection that does not clear completely, or the result of recurrent ear infections. The infection may spread into the mastoid bone (mastoiditis), or pressure from fluid build-up may rupture the eardrum or damage the bones of the middle ear.

A chronic ear infection may be more destructive than an acute ear infection because its effects are prolonged or repeated, and it may cause permanent damage to the ear. However, a chronic, long-term infection may show less severe symptoms -- so the infection may remain unnoticed and untreated for long periods of time.

Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.


Note: Symptoms may be continuous or intermittent, and may occur in one or both ears.

Signs and tests

An examination of the ear may show dullness, redness, air bubbles, or fluid behind the eardrum. The eardrum may show drainage or perforation (a hole in the eardrum). The eardrum may bulge out or retract inward.

Cultures of drainage may show bacteria. These bacteria may be resistant or harder to treat than the bacteria commonly involved in acute ear infection.

CT scan of the head or mastoids may show spreading of the infection beyond the middle ear.


Treatment is focused on relief of symptoms and cure of the infection. Antibiotics may be prescribed if the infection appears bacterial. Antibiotic treatment is usually long-term and may be oral or in the form of antibiotic ear drops if there is a hole in the eardrum.

Surgical removal of the adenoids may be necessary to allow the eustachian tube to open. A surgical opening may be made in the eardrum (myringotomy) to allow fluid to drain. This may or may not include placement of drainage tubes in the ear. Surgical repair of a ruptured eardrum may prevent further chronic ear infections.

Keep the ears clean and dry to prevent reinfection. This is particularly important if myringotomy has been performed.

Expectations (prognosis)

Chronic otitis usually responds to treatment, but treatment may be prolonged (over several months). The disorder may be uncomfortable and may result in serious complications.



Surgery is usually required to:

  • 1. make the ear safe
  • 2. reconstruct hearing




What is otosclerosis?

Hearing impairment may be caused by otosclerosis, a disease of the ear bone. Otosclerosis is a common cause of hearing impairment and is hereditary. Someone in earlier generations of your family had the condition and passed it down to you. Similarly, your descendants may inherit this tendency from you, although the hearing impairment may not manifest itself for a generation or two. Being hereditary, diseases such as scarlet fever, ear infection, measles and influenza have no relationship to the development of otosclerosis.

How does the normal ear funciton?

The ear is divided into three parts: the external ear, the middle ear and the inner ear. The external ear collects sound, the middle ear mechanism transforms the sound and the inner ear receives and transmits the sound. Sound vibrations enter the ear canal and cause the ear drum membrane to vibrate. Movements of the membrane are transmitted across the middle ear to the inner ear fluids by three small ear bones.These middle ear bones (hammer or malleus, anvil or incus and stirrup or stapes) act as a transformer, changing sound vibrations in air into fluid waves in the inner ear. The fluid waves stimulate delicate nerve endings in the hearing canals. Electrical impulses are transmitted on the nerve to the brain where they are interpr-eted as understandable sound.

What are the different types of hearing impairment?

The external ear and the middle ear conduct sound; the inner ear receives it. If there is some difficulty in the external or middle ear, a conductive hearing impairment occurs. If the trouble lies in the inner ear, a sensorineural or nerve hearing impairment is the result. When there is difficulty in both the middle and the inner ear a mixed or combined impairment exists. Mixed impairments are common in otosclerosis.

What are the types of hearing impairment from otosclerosis?

Had we been able to examine your inner ear under a microscope before a hearing impairment developed, we would have seen minute areas of both softening and hardening of the bone. This process may spread to the stapes, the inner ear, or to both these areas.

Cochlear Otosclerosis When otosclerosis spreads to the inner ear a sensori-neural hearing impairment may result due to interference with the nerve function. This nerve impairment is called cochlear otosclerosis and once it develops it is permanent. In selected cases medication may be prescribed in an attempt to prevent further nerve impairment. On occasion the otosclerosis may spread to the balance canals and may cause episodes of unsteadiness.

Stapedial Otosclerosis Usually otosclerosis spreads to the stapes or stirrup bone, the final link in the middle ear transformer chain. The stapes rests in a small groove, the oval window, in intimate contact with the inner car fluids. Anything that interferes with its motion results in a conductive hearing impairment. This type of impairment is called stapedial otosclerosis and is usually correctable by surgery. The amount of hearing loss due to involvement of the stapes and the degree of nerve impairment present can be determined only by careful hearing tests.

What is the treatment of otosclerosis?

Medical There is no local treatment to the ear itself or any medication that will improve the hearing in persons with otosclerosis. In some cases medication may be helpful in preventing further loss of hearing.

Surgical The stapes operation (stapedectomy) is recommended for patients with otosclerosis who are candidates for surgery. This operation is performed under local anesthesia and requires but a short period of hospitalization and convalescence. Over 90 percent of these operations are successful in restoring the hearing permanently.


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