Types of Ear Surgery

Ear surgery has advanced at a rapid pace over the last few years. Operations have become more intricate, using microsurgery techniques and laser tools to repair damaged structures within the inner ear, and to fit implants that enable profoundly deaf people to detect sounds. Cosmetic ear surgery has also developed; in addition to the traditional ear pinning surgery to treat ‘bat ears’, it is now possible to replace the entire pinna if it is lost in an accident.

Microsurgery on the Ear

The structures inside the ear are very small, so the development of microsurgery has made it easier to perform more extensive surgery within this confined space. Microsurgery is used for ear drum repair, to locate and remove small ear tumours, and to repair the bones within the ear if they have become damaged, or have degenerated. Surgery is performed through the ear drum, and then involves an ear drum reconstruction.

Laser Surgery and the Ear

Laser surgery is an integral technique used in the operation to replace damaged inner ear bones. The instruments are introduced into the inner ear through an incision in the ear drum, and then a laser is used to vaporise what is left of the damaged hammer, anvil or stirrup bone. This technique is far better than using tools to physically break up the bone remnants, as the very act of chipping in the inner ear can damage the delicate sensory cells involved in hearing.

Fitting a Cochlear Implant

Surgery to fit a cochlear implant is a tricky procedure and the operation can take about 4 hours. A general anaesthetic is required and it is normal to have to stay in hospital for at least two days. Although the microphone part of the cochlear implant is worn on the outside of the skull, usually just above the ear, the internal components have to be implanted under the skin and inside the inner ear itself. The processor is implanted under the skin and is attached to the microphone and then the processor is linked to tiny micro electrode arrays that are implanted directly inside the cochlea, and attached to the auditory nerve. After about 6 weeks of healing, the processor is activated, and then a long and intense period of training begins, to enable the person with the implant to the maximum benefit from it.

Removal of Ear Tumours

Ear tumours are rare but even very small tumours such as acoustic neuromas that form inside the inner ear, particularly on the auditory nerve, can have a severe impact on hearing and the sense of balance. Surgery to remove such tumours can be successful, but microsurgery and great skill is required to avoid damaging the nerve and sensory cells in the process. Surgeons are trying to improve the techniques all the time and a recent research study showed a greater chance of success if the incision was made behind the ear, to gain access to the tumour, rather from coming in from the top of the ear.

Ear Drum Reconstruction

Usually done under general anaesthetic, ear drum repair, or tympanoplasty, is a surgical technique that needs to be done with a microscope. Incisions are made in the front and back of the ear, so that the surgeon can inspect the inner ear for potential damage before repairing the perforated ear drum using a piece of tissue take from the back of the ear or from the tragus, the lobe of cartilage that sits at the front of the ear, next to the cheek. Sometimes, a gelatin insert is used to support the graft while it heals.

Inserting Ear Grommets

An operation to insert ear grommets is a common treatment for glue ear, which occurs in children who suffer from repeated ear infections. Other treatments such as antibiotics and anti-inflammatory drugs are used first, to try to solve the problem, but if these do not work and the child’s hearing deteriorates, small drainage tubes, the grommets, are inserted through the ear drum and into the middle ear. Once in place, this allows fluid to escape easily from the usually closed cavity of the inner ear, which relieves pressure and pain and reduces the chance of infection.

After a few months, the ear drum heals naturally and the grommet is pushed out; hopefully by then it has done its job and the inflammation and problems within the middle ear do not recur.

Pinna Replacement

Cosmetic surgery on the ear can now offer a complete pinna replacement, using an artificial ear moulded from silicone. This can match the other ear very closely, and when inserted under the skin, gives the appearance of a natural ear, rather than a prosthetic ear.