Otologic surgery corrects issues ranging from hearing loss and chronic infection to trauma and congenital malformations. The ear is a delicate, three-part organ with interconnected functions for hearing and balance. The specific surgical approach depends entirely on which anatomical region—the outer, middle, or inner ear—is affected. These targeted interventions aim to restore function, alleviate pain, and improve the patient’s quality of life.
Procedures Targeting the Outer Ear
The outer ear consists of the auricle (pinna) and the external auditory canal leading to the eardrum. Surgeries here often address cosmetic concerns, repair injuries, or remove obstructions. Otoplasty, often called “ear pinning,” reshapes or repositions the auricle. It involves altering the cartilage to bring ears closer to the head or correct deformities. This surgery is frequently performed on children after age six, when the ear has reached nearly its adult size.
Other procedures involve reconstruction to repair injuries or congenital defects, such as microtia, where the ear is underdeveloped or missing. Surgeons may use the patient’s own rib cartilage or a synthetic implant to create a new ear framework covered with skin. Canalplasty may also be performed to widen a narrowed ear canal. This condition is sometimes caused by bony growths called osteomas, which can impede hearing and trap debris.
Procedures Targeting the Middle Ear
The middle ear is an air-filled space containing the eardrum (tympanic membrane) and three hearing bones: the malleus, incus, and stapes. Procedures here aim to restore the mechanical transmission of sound and clear persistent infection.
Myringotomy is a frequently performed middle ear surgery, often combined with the placement of a tympanostomy tube (ear tube). A small incision is made in the eardrum to drain fluid. A ventilation tube is then inserted to equalize pressure between the middle ear and the atmosphere. This prevents fluid accumulation and reduces the frequency of acute ear infections, particularly in children.
Tympanoplasty repairs a perforated eardrum using a tissue graft, often taken from behind the ear or cartilage. This repair prevents chronic infection and helps improve hearing. When the ossicles are damaged by infection or trauma, ossiculoplasty reconstructs the sound pathway. This involves reorganizing existing bones or replacing them with a titanium prosthesis to transmit sound vibrations to the inner ear.
Stapedectomy
Stapedectomy is indicated for patients with otosclerosis, where the stapes bone becomes fixed and unable to vibrate. The fixed stapes is removed and replaced with a prosthetic device. This artificial component restores the proper movement of sound energy, significantly improving conductive hearing loss.
Procedures Targeting the Inner Ear
The inner ear houses the cochlea, which converts sound vibrations into electrical signals, and the vestibular system, which manages balance. Surgeries here are highly specialized, often involving implantable devices or procedures to control severe balance disorders.
Cochlear implantation is a major intervention for individuals with severe sensorineural hearing loss who receive little benefit from traditional hearing aids. The procedure implants an electrode array directly into the cochlea, bypassing damaged hair cells. The device stimulates the auditory nerve, allowing the brain to perceive sound.
For intractable and debilitating vertigo, such as that caused by Meniere’s disease, destructive procedures may be considered. A labyrinthectomy involves surgically removing the inner ear balance organ (labyrinth) to stop abnormal balance signals. This procedure is reserved for patients who have already lost all usable hearing in the affected ear because it results in total hearing loss.
A less destructive option is a vestibular nerve section, where the balance portion of the vestibulocochlear nerve is selectively cut. The goal is to control vertigo attacks while preserving the patient’s remaining hearing function. Both labyrinthine procedures are last-resort options when all other medical treatments have failed.
General Principles of Recovery and Post-Operative Care
Recovery following any ear procedure requires adherence to specific guidelines to ensure proper healing and avoid complications. A primary instruction is to keep the surgical ear completely dry for a specified period, often by placing a petroleum jelly-coated cotton ball in the outer ear canal during showering. Patients must also avoid activities that increase pressure in the head, which can disrupt the surgical site.
Restrictions commonly include avoiding heavy lifting, strenuous exercise, and flying for several weeks. Patients are instructed to sneeze with their mouth open and refrain from blowing their nose forcefully. This prevents pressure from reaching the middle ear space through the Eustachian tube.
Temporary symptoms are common as the ear heals. These may include mild dizziness, a metallic taste sensation, and a feeling of muffled hearing or fullness. This muffled feeling is often due to packing placed in the ear canal or middle ear during the procedure. Follow-up appointments are scheduled within one to two weeks to monitor the incision site, remove non-dissolvable stitches, and check healing progress.