Ear Surgery | Ear Specialist Dr Rebecca Heywood

Tel: 65 6950 2869

Surgery

Ear Surgery

Cochlear Implant Surgery

What is cochlear implant surgery?

Cochlear implant surgery is an operation performed to put the internal component of a cochlear implant under the skin behind the ear, and place the delicate implant electrode in to the inner ear (cochlea).

When is cochlear implant surgery recommended?

Cochlear implantation is recommended to restore hearing in people who struggle to hear with a conventional hearing aid. You can learn more about when a cochlear implant is necessary here.

What happens during the procedure?

Cochlear implant surgery is performed under general anaesthetic. An incision is made behind the ear to open the mastoid bone leading to the middle ear space and an opening is made in the cochlea where the implant electrodes are inserted. The cochlear implant device is placed behind the ear under the skin.

A few weeks after surgery, once the site has healed, we will place the signal processor, microphone, and implant transmitter outside the ear and switch on the device.

What is recovery like after cochlear implant surgery?

Patients may go home the same day or the day after the surgery in most cases.

What are the risks associated with cochlear implant surgery?

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Eustachian Tube Balloon Dilatation

What is Eustachian tube balloon dilatation?

This is a procedure that is performed to help the Eustachian tube open more easily by dilating it with a small balloon. The Eustachian tube connects the back of the nose and the middle ear and usually allows the pressure to equalise between the two.

When is Eustachian tube balloon dilatation recommended?

Eustachian tube balloon dilatation is used to treat symptoms and signs of obstructive Eustachian tube dysfunction, such as difficulty equalising when flying, a sensation of fullness or blockage in the ear, glue ear and retraction of the eardrum.

What happens during the procedure?

The procedure can be carried out under local anaesthetic with or without light sedation, or general anaesthetic. Using a small camera, a thin tube is passed through the nose and into the Eustachian tube. A small balloon at the end of the tube is dilated for two minutes and then the tube and the balloon are removed through the nose.

What is recovery like after the procedure?

It may take up to 6 weeks for the effect of the balloon on the Eustachian tube to start to work. There may be some mild discomfort or nasal congestion for 1-2 days after the procedure. Recovery is otherwise very fast and relates to sedation of general anaesthetic if these are used.

What are the risks associated with Eustachian tube balloon dilatation?

Eustachian tube balloon dilatation is a simple and safe procedure with a very low risk profile. Sometimes there may be lack of symptom improvement or a small amount of bleeding from the nose. Occasionally the Eustachian tube may be dilated too much, leading to a condition called patulous Eustachian tube.

Grommet Insertion

What is a grommet insertion?

A grommet is a small ventilation tube inserted into the ear drum. This procedure is carried out to remove fluid behind the ear drum, allow air into the middle ear and prevent further build-up of fluid.

When are grommets recommended?

Grommets are often recommended if glue ear (fluid in the middle ear) causes persistent hearing loss. In children this may affect their speech, language or schooling. Grommets are also used to treat recurrent otitis media (middle ear infection) and Eustachian tube dysfunction.

What happens during surgery?

The procedure is usually carried out under a short general anaesthetic in children and local anaesthesia in adults (unless they request otherwise). A tiny hole is made in the eardrum under the microscope and the grommet is inserted in to the hole to keep it open. The grommet will usually stay in place for 6 to 18 months before it extrudes and the eardrum closes behind it.

What is recovery like after the operation?

You will be able to go home straight after the procedure, or later the same day if the surgery was performed under general anaesthesia. The ear may ooze for a day or two. This is normal.

You may clean the outer ear, but not the ear canal. Also avoid getting the ear wet during the recovery period. Any ear drops prescribed should be given as instructed to complete the course.

What are the risks associated with grommet insertion?

Glue ear occurs due to a problem with the ventilation of the middle ear. If this problem persists, then the glue ear may come back when the grommet falls out. A repeat procedure may be performed and combined with an adenoidectomy to reduce the chance of the glue ear coming back again.

A small number of patients have persistent or recurrent discharge from the ear after the surgery. This will usually resolve with antibiotic ear drops. In rare cases, the grommet may need to be removed.

In about 2% of patients, the hole in the eardrum does not close properly when the grommet falls out. This may need to be closed with a small surgical procedure.

In-the-ear (intratympanic) Steroid Injection

What is an in-the-ear steroid injection?

An in-the-ear steroid injection is an injection of steroid medicine through the eardrum into the middle ear space.

When is In-the-ear steroid injection recommended?

Steroids are injected into the ear to treat sudden hearing loss and Meniere’s disease. Steroids can also be administered orally (by tablets) for sudden hearing loss. They are given via an in-the-ear injection when oral steroids have not had the desired effect, to supplement the oral steroids, or when patients do not want or are unable to take oral steroids due to other medical conditions.

What happens during the procedure?

The procedure is usually carried out under local anaesthesia. A microscope is used to inject steroid medicine through the eardrum via a very thin needle into the middle ear (space behind the eardrum). You will need to remain lying down with your head turned to the side for half an hour after the injection. This will allow time for the steroid medicine to diffuse through into the inner ear. The procedure may need to be repeated over days (sudden hearing loss) or months (Meniere’s disease).

What is recovery like after the procedure?

There may be mild discomfort associated with the procedure and for 30-90 minutes afterwards. Some people experience mild dizziness after the procedure but this is usually short-lived.

What are the risks associated with In-the-ear steroid injection?

The ear may feel blocked due to the fluid behind the eardrum, sometimes for several days. Rarely (<1%) the hole made in the eardrum by the needle does not close. This is usually asymptomatic but if it causes any problems then a small procedure to close the hole may be required.

Labyrinthectomy

What is a labyrinthectomy?

A labyrinthectomy is a surgical procedure that is performed to treat severe vertigo for patients who have not responded to more conservative treatment options. The inner ear vestibular (balance) organs are removed to relieve the symptoms associated with vertigo. It is also performed to remove inner ear tumours. The procedure results in complete loss of the remaining balance and hearing. It is, therefore, sometimes performed in conjunction with a cochlear implant.

What happens during a labyrinthectomy?

The inner ear is accessed through the mastoid bone behind the ear. The balance part of the inner ear is completely removed.

What is recovery like after the operation?

You will be observed in hospital for a few days after the operation and discharged only when you have regained enough balance to care for yourself at home. Some patients may need a walking stick temporarily or permanently. You may also be referred to a physical therapist if you need vestibular or balance therapy in order to more effectively recover your balance. Around 95 per cent of patients experience relief after a labyrinthectomy.

What are the risks associated with a labyrinthectomy?

The reason that this surgery is considered as a last resort is that there are severe risks associated with it, including:

Leakage of brain fluid (CSF)
Complete loss of hearing in the affected ear
Facial nerve injury leading to facial weakness
Loss of balance function in affected ear
Vomiting or nausea
Symptoms not being eliminated

Ossiculoplasty

What is ossiculoplasty?

Ossiculoplasty is an operation performed to reconstruct the hearing bones of the middle ear when they have been eroded by disease or do not work. This results in conductive hearing loss because the sound cannot be transmitted effectively from the eardrum to the inner ear.

What happens during ossiculoplasty?

Ossiculoplasty can be performed under local anaesthetic with sedation or general anaesthetic. It may be performed down the ear canal, or in more complex cases, through a discrete incision above the ear canal or behind the ear. A microscope or endoscope is used to visualise the middle ear. The eardrum is lifted and the hearing bones inspected to work out where the problem is. An ossicular prosthesis is used to reconnect the eardrum and inner ear.

What is recovery like after the operation?

The ear canal is packed after the operation. The packing should only be removed at your follow-up appointment in clinic. Keep the ear dry while the ear drum heals and avoid activities that will cause rapid pressure changes in the ear such as coughing, sneezing, blowing your nose or straining. For this reason also avoid lifting heavy weights and flying for the first 4-6 weeks. If you have to cough or sneeze, do so with an open mouth to minimise pressure changes. Most people will take one week off work.

How successful is an ossiculoplasty?

This depends on your condition and will be discussed in detail with you. In general, hearing will improve in 9 out of 10 patients.

What are the risks associated with ossiculoplasty?

Ossiculoplasty is a safe and commonly performed procedure. Some risks that you should be aware of include:

Persistent hearing loss
You may have a metallic taste at the tip of the tongue on the side of the surgery. This is common but temporary in most cases.
Temporary vertigo or imbalance occurs occasionally.
Pre-existing tinnitus may deteriorate in rare cases. Usually, it improves or stays the same.

Semicircular Canal Dehiscence Surgery

What is Canal Dehiscence Surgery?

This surgical procedure is performed to close a defect in the affected semicircular canal and bring relief from hearing and balance symptoms.

What happens during surgery?

Access to the superior semicircular canal is gained either via an opening called a craniotomy in the part of the skull called the middle fossa, or through the mastoid bone behind the ear in some cases. The semicircular canal is either plugged to eliminate fluid movement within it, or resurfaced to close the hole in the canal.

What is recovery like?

A few weeks after surgery, once the site has healed, we will place the signal processor, microphone, and implant transmitter outside the ear and switch on the device.

Patience and commitment is essential as you learn to hear again. These devices do not restore normal hearing, but if you persevere with rehabilitation, there is a good chance of restoring some hearing.

We will teach you how to listen to sound through the implant and how to care for it. Some patients may take longer than others to learn to hear again and require more training due to individual differences like how long they have been without sound. We will schedule follow-up check-ups to readjust the speech processor as needed.

Stapes Surgery (Stapedectomy/

Stapedotomy)

What is Stapes Surgery?

Stapes surgery, also known as stapedectomy or Stapedotomy, is an operation performed to treat conductive hearing loss due to fixation of the stapes, the innermost hearing bone in the middle ear. This most commonly occurs due to otosclerosis. The surgery re-establishes the chain for transmission of sound waves from the ear drum to the inner ear to improve the hearing.

What happens during Stapes Surgery?

The surgery is performed under general or local anaesthesia. A microscope is used to look down the ear canal and the eardrum is lifted to gain access to the middle ear. A laser is used to remove the upper part of the stapes and make a small hole in the stapes footplate. A tiny piston is then inserted into the hole and attached to the second hearing bone (the incus). The ear drum is then replaced and the ear is packed.

What is recovery like?

You will not be able to appreciate the change in your hearing until the pack is removed from the ear in clinic one to two weeks after surgery. The ear must be kept dry until it has healed. You may need to take from a few days up to two weeks off work depending on the nature of your work. You should avoid flying for six weeks after surgery.

How successful is Stapes Surgery?

Stapes surgery results in hearing improvement in 9 out of 10 patients. Stapes surgery cannot reverse inner ear damage caused by otosclerosis or other conditions.

What are the risks of Stapes Surgery?

1 in 200 patients may experience permanent inner ear hearing loss.
You may have a metallic taste at the tip of the tongue on the side of the surgery. This is temporary in most cases.
Temporary vertigo or imbalance occurs occasionally.
Pre-existing tinnitus may improve or stay the same. In rare cases, it can deteriorate.

Tymponoplasty

What is a Tympanoplasty?

Tympanoplasty is a procedure to repair a perforated or retracted eardrum. It may be performed at the same time as an ossiculoplasty.

What happens during tympanoplasty?

Tympanoplasty is performed under local anaesthesia with light sedation or general anaesthesia. It may be performed down the ear canal, or in more complex cases, through an incision above the ear canal or behind the ear. A microscope or endoscope is used to visualise the eardrum. A graft made from cartilage or fascia is placed under the eardrum as a scaffold for the eardrum to grow across.

What is recovery like after the operation?

For this reason also avoid lifting heavy weights and flying for the first 4-6 weeks. If you have to cough or sneeze, do so with an open mouth to minimise pressure changes. Most people will take one week off work.

What are there risks associated with a tympanoplasty?

Tympanoplasty is a safe and commonly performed procedure.

Some risks that you should be aware of include:

A persistent hole in the eardrum in 1 in 20 patients
The hearing does not improve in approximately 1 in 10 patients.
You may a metallic taste at the tip of the tongue on the side of the surgery. This is common but temporary in most cases.
You may have Temporary vertigo or imbalance.
Pre-existing tinnitus may improve or stay the same. Rarely it can deteriorate.

Tympanomastoid Surgery

What is a Tympanomastoid surgery?

Tympanomastoid surgery or tympanomastoidectomy is a surgical procedure to treat chronic middle ear disease, most commonly cholesteatoma. The surgery is performed to remove the cholesteatoma, repair the areas that have been damaged, and prevent any further damage from occurring.

What is involved with a tympanomastoid surgery?

The operation is performed under a general anaesthesia and takes 2 to 4 hours, depending on the complexity. An incision is made behind the ear, followed by drilling into the mastoid bone behind the ear to get to the cholesteatoma sac and the middle ear space. The surgery is performed in two stages.

The first stage is to remove the sac completely, which may involve the ear canal, ear drum, middle ear, bones of hearing, mastoid bone, facial nerve, balance organ and even brain lining.

The second stage involves repairing any damage caused by the cyst. This may be replacing eroded bone with cartilage and damaged bones of hearing with a prosthesis to restore hearing (ossiculoplasty). In some cases the ossiculoplasty may need to be delayed and done at a later date.

What is recovery like after the operation?

You can expect to return home later the same day or the next morning. The head bandage applied is removed the following morning but the packing placed in the ear to help prevent infection will be removed in the clinic two to three weeks later. You will have reduced hearing until the packing is removed.

Keep the ear dry and avoid rapid air pressure changes and anything that ‘pops’ your ears for the first 6 weeks. This includes coughing, sneezing, blowing your nose and flying. You are advised to stay off work or school for 1 week and avoid strenuous exercise.

What are the risks associated with a tympanomastoidectomy?

While a tympanomastoidectomy is a routine and safe procedure, as with any surgery, there are risks, including:

Infection. The risk of this is reduced by using antibiotics
Bleeding. The risk of this is reduced by using a head bandage to put pressure on the wound at the end of the surgery.
Reduction in hearing. Some of the hearing bones may have to be removed if they have been damaged by the cholesteatoma, which may lead to a reduction in hearing. This is reconstructed during surgery if possible. Rarely there may be permanent damage to the inner ear.
A metallic taste at the tip of the tongue on the side of the surgery. This is common but temporary in most cases.
Temporary vertigo or imbalance.
Pre-existing tinnitus may deteriorate in rare cases. It may improve or stay the same.
A small but serious risk to the facial nerve that supplies the muscles of the face on the side of the operation. Damage to this results in weakness of the muscles of the face. It is rare for this to happen, and if it does it is usually temporary. The risk of facial nerve damage is reduced by utilisation of a facial nerve monitor during the surgery and pre-operative imaging to ascertain any abnormality in the course of the facial nerve.
Leakage of CSF (brain fluid). It is rare for this to happen unless the cholesteatoma has already damaged the bone and brain lining between the brain and the ear. If this happens it is repaired at the time of the surgery.