Ear Institute : Procedures

Procedures

The following is a list of some of the procedures done at the University of Miami Ear Institute. The descriptions do not constitute a complete or detailed definition of each procedure, but rather a brief general description. Procedures and surgeries are constantly evolving. Please use this as a guide only.

Surgery for hearing loss

Stapedectomy – a surgical treatment for otosclerosis, a disease of ear bone degeneration that causes the stapes (a bone in the middle ear) to become fixed and prevents it from vibrating normally. During stapedectomy surgery, the stapes bone is removed (typically with a micro-laser), and a prosthesis of various materials is inserted in the middle ear as a replacement.

Ossicular reconstruction (Middle ear prosthesis) – a surgical procedure to correct hearing loss from an abnormal middle ear bone(s). One, two, or all three of the middle ear bones are replaced with prosthetic hearing bones.

Cochlear implantation – involves the surgical implantation of a computerized electronic device designed to help people with nerve deafness who gain little or no benefit from hearing aids. The device converts sound energy to electric impulses that stimulate the nerve of hearing directly.

Implantable auditory prosthesis (Implantable hearing aid) – an implantable middle ear hearing device that amplifies sound like a standard hearing aid. The implantable prosthesis vibrates the middle ear bones in the ossicular chain directly, rather than amplifying the sound through the ear canal.

Bone Anchored Hearing Aid (BAHA) – a hearing device that allows direct bone-conduction through a titanium implant and vibrator implanted into the skull. It is useful for patients who cannot use conventional air-conduction hearing aids, for example patients without ear canals.

Surgery for ear infections and chronic ear disease

Myringotomy tubes – small tubes that are surgically placed into a child’s eardrum by an ear, nose, and throat surgeon. The tubes may be made of plastic or metal and help restore hearing and reduce risk of ear infections.

Tympanoplasty – the repair of perforations, or holes, in the eardrum (tympanic membrane) and can also involve repair of the middle ear bones. Eardrum perforations (holes) can be caused by trauma or infection.

Mastoidectomy – an operation to remove chronic infection or other disease from the bone behind the ear (the mastoid bone) when medical management is inadequate. The most common indication is ‘cholesteatoma’, a benign growth of the middle ear and mastoid bone. Cholesteatoma may destroy adjacent structures of both hearing and balance and has a high recurrence rate, especially in children.

Surgery for tumors of the ear and temporal bone skull base

Acoustic neuroma – a benign, slow growing tumor arising from the eighth cranial nerve, which supplies hearing and balance sense to the brain. Although benign, it often requires removal because of its size and compression of surrounding structures. A team of skull base surgeons and other specialists provide care for these patients with complex issues. Gamma knife surgery is also sometimes recommended.

Glomus tumors – slow glowing vascular tumors, are the most common tumors of the middle ear. Glomus tumors arise near sensitive structures of the head and neck such as the carotid artery, jugular vein, cranial nerves of speech and swallowing, and even into the brain. Again, a team of skull base specialists is involved to maximize the chances of curing the tumor while preventing serious complications.

Meningiomas – tumors that originate from the meninges that surround the brain and spinal cord. Typically they are benign, but instances of malignancy do occur. Meningiomas may present to the otolaryngologist with signs similar to an acoustic neuroma (see above.)

Malignant tumors (cancer) – described as an uncontrolled growth of abnormal cells that have mutated from normal tissues. They are termed malignant when they can spread to distant sites like lymph nodes or the lungs and liver. Cancer of the ear most commonly arises in the ear canal and can have symptoms such as chronic ear drainage, crusting, and bleeding. Treatment may involve both surgery and radiation.

Other surgeries

Facial nerve repair – The facial nerve is responsible for movement of the face. It can be damaged through a variety of ways, such as trauma, chronic infection, surgery, or cancer. In many cases, microsurgical repair is possible to restore function.

Facial nerve decompression – involves drilling out the narrow canal through which the facial nerve travels. Decompression is usually done to relieve pressure on the nerve from trauma or inflammation caused by infection. If unrelieved, the pressure can inhibit normal facial nerve function, resulting in a one-sided facial paralysis or weakness.

Repair of fistula for hearing loss – A fistula of the inner ear is an abnormal connection between the fluid-filled inner ear and the air-filled middle ear. This can result in dizziness and hearing loss. The repair involves patching the leak in the middle ear and can be done through the ear canal.

Surgery for Meniere’s disease and vertigo – Surgery is only recommended where medical treatment fails to relieve the attacks of dizziness, hearing loss, ringing, and pressure.

Endolymphatic sac mastoid shunt – is an operation that reduces inner fluid pressure. This operation is advised when hearing is relatively good. An incision is made behind the ear and the mastoid bone is drilled for exposure to the endolymphatic sac, the organ responsible for inner ear fluid pressure. The sac is opened and, in some instances, a small stent placed inside.

Vestibular nerve section – the process of cutting the balance nerve. This is done when other attempts to control recurrent vertigo attacks have failed. This procedure prevents the abnormal balance signals – caused by Meniere’s disease – from reaching the brain and causing symptoms.

Labyrinthectomy – involves removing the balance organs of the inner ear in an attempt to cease all abnormal balance signals from reaching the brain and causing symptoms. As this procedure destroys the hearing as well, it is only performed when there is no useful hearing in the ear. This procedure also involves drilling the mastoid bone (see above).

Transtympanic injections of steroids and gentamicin – These techniques are used to deliver medicines directly to the inner ear without exposing the entire body to the same medications. This is done in an office setting by making a small incision in the eardrum and injecting the medicine into the middle ear, where it then is absorbed into the inner ear across thin dividing membranes. Steroids are generally used to decrease inflammation, while the gentamicin is used to reduce or eliminate the signals emanating from the balance organs of the inner ear (similar to labyrinthectomy described above) while attempting to preserve hearing.