Ear surgery and hearing-improving operations

Chronic otitis media is present when there is a defect in the eardrum. No improvement can be achieved with medication. This is often associated with chronic secretions from the ear. Foul-smelling secretions in particular should be seen as a warning symptom, as there may be a so-called bone suppuration behind the ear. This can lead to destruction of the surrounding tissue, in particular the ossicles, the bone of the organ of balance and even damage to the facial nerve. Sometimes, however, a chronic ear infection only involves a defect in the middle of the eardrum. The only effective therapy here is microscopic ear surgery.

The aim of ear surgery is to eliminate the pathological process in the middle ear. If this has led to destruction of the ossicular chain, the ossicles must be restored. This is done using small middle ear prostheses. We use prostheses that are made of titanium. The particular advantage of these titanium prostheses is that they are extremely light, weighing only 4 mg. Titanium is also a material with very good biocompatibility properties. Titanium as a biomaterial is also very rigid. Overall, the properties are suitable for ensuring good sound transmission. The titanium prosthesis is placed either on the movable stirrup or on the movable footplate. A small piece of cartilage is placed on the head of the prosthesis, which then restores the covering to the eardrum. A tamponade is then inserted, which remains in the ear canal for three weeks and is removed after three weeks. Depending on the extent of the operation, it is performed either under local anesthesia or under general anesthesia and either on an outpatient or inpatient basis.

The acute inflammation usually heals without consequences. However, if there is chronic inflammation of the middle ear, ear microscopy will always reveal a hole in the eardrum. Sometimes even the ossicular chain is interrupted. This is noticeable in the form of hearing loss. The eardrum defect can be surgically closed and/or the ossicular chain can be restored in the same operation. The restoration of the ossicular chain is also known as ossiculoplasty. We perform the procedure on an inpatient basis using the latest generation of surgical microscopes and – if medically necessary – use titanium prostheses that are only approx. 2.5 – 4.5 mm long. This type of ear surgery requires many years of training and extensive experience. A defective eardrum is reconstructed with a cartilage graft, cartilage skin graft (perichondrium) or with fascia from a muscle. After the operation, a tamponade is inserted into the ear canal, which is usually left in place for 3 weeks. After 3 weeks, the tamponades are removed in the practice.

With middle ear diseases, there is often a chronic secretion of fluid from the ear. If this fluid has a foul-smelling odor, chronic bone suppuration (cholesteatoma) must be ruled out. If left untreated, a cholesteatoma can lead to significant problems in the ear because the inflammation can spread into the bone and destroy important neighboring structures. It is therefore essential to carefully repair the middle ear with a precise microsurgical technique in the case of a cholesteatoma. It is not uncommon to find a destroyed ossicular chain that needs to be reconstructed. We perform these procedures as part of a short inpatient stay of around two nights.

Hearing loss that develops over many years can be caused by otosclerosis. In such cases, the examination reveals an intact eardrum and a pronounced disturbance of sound transmission in the middle ear. In most cases, otosclerosis is also hereditary. There are entire families in which several family members suffer from otosclerosis. Fortunately, hearing-improving microsurgery of the ear can help many patients. There is usually an otosclerotic plaque between the ossification of the footplate and the stapes. To restore normal sound transmission, the connection between the middle and inner ear must be established by replacing the stapes. Various types of prostheses can be used for this purpose. The microsurgical procedure to restore sound transmission in otosclerosis is called a stapedotomy.

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