Otologic surgery encompasses a range of procedures performed on the ear, primarily aimed at restoring hearing function, managing chronic infection, or correcting structural anomalies. The type of surgery depends on which of the ear’s three main parts—the external ear and canal, the middle ear, or the inner ear—is affected by disease or injury. Intervention often seeks to improve sound transmission, either by repairing a damaged mechanical pathway or by implanting a device to stimulate the auditory nerve directly.
Operations on the External Ear and Canal
The external ear comprises the pinna (auricle) and the external auditory canal. Surgeries in this region typically address cosmetic concerns or physical obstructions that impede sound entry or drainage. Otoplasty is a common procedure that reshapes the pinna, most often performed to correct prominent ears by setting them back closer to the head. This involves surgically modifying or removing cartilage to create a more desirable shape.
Other external ear procedures focus on the ear canal, such as correcting stenosis, which is the narrowing of the passage. Stenosis may be congenital or result from repeated infection, trauma, or bone growths called exostoses. Surgical correction involves widening the bony or cartilaginous canal walls to ensure proper drainage and prevent debris buildup. These operations ensure sound waves travel effectively to the eardrum, but they do not address hearing loss originating deeper within the system.
Procedures Affecting the Middle Ear
Middle ear surgeries are performed to manage conductive hearing loss, which occurs when sound transmission is blocked or impaired. One common procedure is myringotomy, a small incision in the tympanic membrane (eardrum), often followed by the insertion of a tympanostomy tube. These tiny tubes ventilate the middle ear, allowing fluid to drain and equalizing pressure. The tubes typically remain in place for six to eighteen months before naturally extruding as the eardrum heals.
Tympanoplasty is the surgical repair of a perforated eardrum, using a tissue graft taken from the patient, such as fascia or cartilage, to patch the hole. This procedure prevents chronic infection from entering the middle ear space and helps restore hearing by providing a complete vibrating surface for sound waves. If the three tiny bones of hearing—the malleus, incus, and stapes—are damaged or eroded, a procedure called ossiculoplasty is performed. The damaged bones can be reconstructed using the patient’s own tissue or replaced with prosthetic materials, such as titanium, to restore the mechanical chain that transmits vibrations from the eardrum to the inner ear.
Another specialized middle ear surgery is stapedectomy, which addresses hearing loss caused by otosclerosis. This condition involves abnormal bone growth that fixes the stapes, the innermost hearing bone, preventing it from vibrating and conducting sound. During a stapedectomy, the surgeon removes the fixed stapes bone and replaces it with a tiny piston-like prosthesis. This artificial device restores the connection between the incus and the inner ear fluid, allowing sound vibrations to properly enter the cochlea.
Surgeries for Inner Ear and Complex Hearing Loss
Surgeries involving the inner ear or complex hearing loss address damage to the sensory organs or the auditory nerve itself. Cochlear implantation is reserved for individuals with severe to profound sensorineural hearing loss who receive little benefit from traditional hearing aids. The device works by bypassing the damaged hair cells in the cochlea, transducing acoustic energy into electrical signals. These signals are sent directly to the auditory nerve via an electrode array implanted within the cochlea, allowing the brain to perceive sound.
Candidacy for a cochlear implant is determined by comprehensive testing, including audiometric assessments that measure speech recognition scores. Adults typically need a score of 50% or less on sentence recognition tests in the ear to be implanted. Bone-Anchored Hearing Aids (BAHA) are another type of implantable device, primarily used for conductive or mixed hearing loss and single-sided deafness. The BAHA system uses a surgically placed titanium implant in the skull bone behind the ear to transmit sound vibrations directly to the inner ear, completely bypassing the outer and middle ear structures.
For patients experiencing severe, intractable vertigo, typically associated with Meniere’s disease, procedures can be performed to address the vestibular system. Labyrinthectomy involves surgically removing the balance organs of the inner ear, which reliably eliminates vertigo but results in a complete and permanent loss of hearing in the affected ear. A vestibular neurectomy is an alternative that selectively severs the vestibular nerve. This procedure aims to stop the vertigo signals from reaching the brain while potentially preserving any remaining hearing function.