All about Ear Surgery

When is ear surgery necessary?

First, it's crucial to differentiate between pathologies affecting the tympanic membrane and ossicular chain from those affecting the inner ear and cranial nerves. Another key distinction, within the different structures, must be made between inflammatory diseases (chronic otitis), functional ones (like otosclerosis), and neoplastic ones (neurinomas, meningiomas, tympano-jugular paragangliomas, temporal bone carcinomas).

While intervention is clearly necessary for neoplastic pathologies affecting the ear and base of the skull, it can be more complex for patients to understand when intervention is necessary for inflammatory or functional ear pathologies. Naturally, deafness is the patient's initial alarm signal, followed by our evaluation with a complete clinical picture of the examined pathology.

Middle Ear Surgery

Tympanoplasty

Tympanoplasty repairs or reconstructs the tympanic membrane (myringoplasty or type I tympanoplasty), restoring hearing through one or more incisions (behind the ear and/or the ear canal). Reconstruction uses autologous tissue grafted onto damaged areas.

Canaloplasty

Canaloplasty widens the ear canal in cases of stenosis or malformation, or in conjunction with tympanoplasty to increase operating space. It involves removing portions of bone and using skin grafts to cover the operated area.

Ossiculoplasty

Ossiculoplasty restores the functionality of the ossicular chain (malleus, incus, stapes), and thus sound wave propagation. It's often performed with tympanoplasty. If the patient's ossicles are too damaged, biocompatible prostheses (autologous costal cartilage or donor ossicles) are used.

Mastoidectomy

Mastoidectomy removes damaged bone or creates space to access other damaged ear areas. Two surgical techniques exist:

• Simple (conservative) mastoidectomy preserves ear anatomy without creating a mastoid-ear canal opening;
• Radical mastoidectomy widens and partially reconstructs the ear canal using skin grafts. Often necessary for cholesteatoma, it's associated with tympanoplasty and ossiculoplasty. While we always aim to restore normal morphology, anatomical modifications necessitate meticulous post-operative hygiene.

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Are there surgical remedies for deafness?

Otosclerosis and Deafness

Deafness is no longer an insurmountable problem. Consider otosclerosis. High-precision micro-drills and miniaturized prostheses allow hearing restoration in under 30 minutes, often under local anesthesia. This technology requires excellent surgical preparation; some results stem directly from meticulous work on surgical technique innovation and team training.

Otosclerosis exemplifies how advancements in surgical techniques have addressed deafness. Totally implantable ear prostheses, such as cochlear implants, represent a definitive evolution in our surgical capabilities.

Auditory Implantology to Correct Deafness

Regardless of the cause (provided it's severe), surgeons can now implant an artificial prosthesis in approximately 60 minutes. This is remarkable, suggesting childhood deafness will be eradicated within a few years.

Auditory implantology also offers hope for patients with auditory nerve tumors who will eventually lose hearing.

Inflammatory Diseases of the Ear: Complications

Simple chronic otitis media with tympanic membrane perforation poses minimal risk. Myringoplasty reconstructs the tympanic membrane, improving hearing and restoring social and active life.

Advanced chronic otitis, such as cholesteatoma, requires surgery not only to address hearing but to prevent serious complications like facial nerve paralysis, meningitis, total hearing loss, and, in extreme cases, cerebral abscesses.

Risks and Complications of Ear Surgery

Patients often worry about potential complications. Modern operating room technologies and biocompatible materials have significantly reduced risks. Antibiotic prophylaxis minimizes infection risk. Ear surgery is generally considered low-risk. Most procedures are performed under general anesthesia with a short hospital stay (usually one night). Post-operative care involves frequent check-ups and monitoring, particularly if multiple surgeries are needed.

The first week post-middle ear surgery requires adherence to hygiene and cautionary rules:

• Keep ears dry;
• Avoid strenuous activity and travel involving sudden pressure changes (avoid mountains).

Some post-operative issues (like vertigo after myringoplasty) are common and shouldn't cause undue concern.

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