Hearing loss is one of the most common sensory impairments seen in almost 10% of the adult population and the percentage markedly increases with ageing. It is the complete or partial loss of hearing ability from one or both the ears.
When the ossicular chain (stapes, incus and malleus bones of the middle ear) is damaged, it drastically affects the hearing, leading to conductive hearing loss. The function of these three ear ossicles are to transmit sound waves from the ear drum to the fluid in the inner ear. Therefore damage to the ossicles, damages the hearing loss.
We hear the sound when the external ear captures the sound, the middle ear transforms that sound and the inner ear receives and transmits the sound. There are many potential causes of conductive hearing loss. When the sound conduction system in the middle ear (ossicles) is damaged by recurrent ear infections, trauma or previous surgery, it affects our hearing.
The anatomy of the middle ear: The malleus is attached to the ear drum on one end and to the incus, at the other end. The incus connects the stapes on one side and malleus on the side. The stapes connects the incus to the oval window of the inner ear. The function of these three ear ossicles is to transmit sound waves from the ear drum to the fluid in the inner ear. Therefore, repairing the ossicles, when damaged helps in restoration of normal hearing.
Ossiculoplasty is a surgery performed to repair, reconstruct and improve the movement of the 3 tiny bones in the middle ear to restore hearing. These bones in the middle ear may have become damaged or less mobile due to infection or disease such as long-standing middle ear infection (otitis media) or trauma such as a head injury.
The surgery involves either reshaping the existing bones so that they work better or replacing them (prostheses). An incision is made either in front or behind the ear to reach the area.
The diagnosis of ossicular damage is established by an otolaryngologist, based upon history and physical examination. Audiometric tests may disclose the type of hearing loss. Radiological investigations like CT or MRI scan may also be advised for confirming the presence of ossicular damage.
The surgery is performed under general anesthesia and takes approximately one to two hours. This is done either by itself or in conjunction with other procedures including mastoidectomy and ossicular chain reconstruction. An incision is made behind the ear to access the ear canal. The eardrum, or tympanic membrane, is carefully elevated from the surrounding canal, and the ossicles are carefully examined and palpated.
If the ossicles are in good condition, one of the ossicles is removed, sculpted into proper shape, and repositioned to reestablish an intact ossicular chain. If this is not possible, a synthetic prosthesis is used to reestablish the ossicular chain. The prosthesis or resculpted ossicle is held in place by a supporting layer of absorbable gelatin sponges placed in the middle ear. The tympanic membrane is then placed back into its proper position. The incision behind the ear is then sutured closed.
The success rate for an ossiculoplasty is very high, though it depends to some extent on the anatomy of the individual patient's ear and the severity of the damage to the bones. Bloody or watery drainage from the incision area may occur during the first 7 - 10 days.
Mild pain is associated with the procedure which subsides by taking pain medications. Preventing the ear from getting wet and preventing the hard blowing of nose is recommended. Tinnitus in the operated ear usually improves with surgery and very rarely this may become worse during the postoperative period. Ear drops should be used as prescribed.
All the activities that increase the blood pressure in head area such as bending over and lifting heavy objects, strenuous exercises should be avoided. Use of aspirin or ibuprofen products for 2 weeks post-operatively is strictly restricted. Flying in an airplane is strictly not advised for six weeks.
Though the success rate of surgery is high (>90%), there is a risk of unchanged hearing or worsened hearing due to ossicle or prosthesis movement. If this occurs, revision surgery may be necessary.
BSR ENT Hospital is a renowned ENT (ear, nose, and throat) hospital located in Secunderabad and Hyderabad with full-time otolaryngologists. BSR staffs the best ENT specialists like Dr. B. Shanker Rao, MS, DLO, FICS and Dr. B. Kalyan Chakravarthy, MS ENT / Head and Neck Surgeon, who are highly qualified with extensive knowledge and experience in problems related to ENT.
Dr. Kalyan Chakravarthy is one of the renowned ENT specialists who also is a consultant with the KIMS Hospitals, with tertiary and quaternary healthcare. Our ENT physicians are specialized in the use of minimally invasive surgery and advanced techniques facilitating the quickest and safest post-op recovery.
The diagnosis and treatment are quick as the hospital is equipped with an in-house laboratory for tests. Above all, the ultimate BSR commitment to the patients' health, well-being and satisfaction are acknowledged by patients, old and new.