Ear and Hearing Surgery

Ear surgery may be considered for several structural or hearing-related disorders, including:

• Otosclerosis
• Conductive hearing loss
• Perforated eardrum
• Chronic middle-ear disease
• Cholesteatoma
• Ossicular chain damage
• Certain forms of severe or profound sensorineural hearing loss
• Hearing loss that is not adequately addressed with conventional hearing aids

The appropriate procedure depends on where the problem occurs within the hearing system. For example, conductive hearing loss can result from problems involving the eardrum or middle-ear bones, while sensorineural hearing loss involves the inner ear or auditory pathway. This distinction is important because the treatment options can be very different.

How Is the Need for Ear Surgery Diagnosed?

Before recommending surgery, an otologic surgeon typically needs to establish the cause and characteristics of the hearing disorder. An evaluation may include:

Medical and Ear History

The physician may ask about:

• When hearing loss began
• Whether it affects one or both ears
• Whether it is stable or progressing
• Previous ear infections or surgery
• Ear drainage or pain
• Tinnitus
• Dizziness or balance symptoms
• Previous hearing-aid use
• Family history of hearing disorders

Hearing Testing

A comprehensive hearing evaluation can help determine whether hearing loss is conductive, sensorineural, or mixed. Testing may include:

• Pure-tone audiometry
• Speech testing
• Tympanometry
• Acoustic reflex testing
• Other specialized audiologic testing when indicated

For patients being evaluated for stapes surgery, audiometry and middle-ear testing are particularly important in determining whether the hearing pattern is consistent with otosclerosis and whether surgery may be appropriate.

Imaging

Depending on the suspected diagnosis, imaging such as a CT scan of the temporal bones may be considered to evaluate the anatomy of the ear and surrounding structures. Imaging is not necessary for every hearing disorder. The need depends on the clinical findings and suspected cause.

No. Hearing loss does not automatically mean that surgery is necessary. Depending on the diagnosis, treatment may include:

• Medical treatment
• Hearing aids
• Assistive listening technology
• Bone-conduction hearing devices
• Implantable hearing devices
• Cochlear implants
• Surgical reconstruction
• Observation and monitoring

For some patients, hearing aids or other hearing technology may provide appropriate benefit. For others, a structural problem such as otosclerosis, a persistent eardrum perforation, cholesteatoma, or damaged middle-ear bones may make surgery an important consideration. The treatment decision should be based on the specific cause of hearing loss and the results of the patient’s evaluation.

The goals vary according to the procedure and diagnosis. Depending on the condition, surgery may be intended to:

Restore sound transmission
Procedures such as stapedotomy and ossicular reconstruction can address mechanical problems in the middle ear.

Repair damaged ear structures
Tympanoplasty can reconstruct a perforated or damaged eardrum.

Remove disease
Cholesteatoma surgery focuses on removing abnormal tissue and controlling disease.

Provide access to an implantable hearing solution
Cochlear implant surgery places the internal component of a cochlear implant for appropriately selected patients.

Preserve hearing when possible
Some ear surgeries are performed with hearing preservation as an important consideration, although individual outcomes cannot be guaranteed.

A surgical consultation generally includes a review of your symptoms, medical and ear history, hearing test results, and the anatomy involved. Your surgeon may discuss:

• The diagnosis
• Whether surgery is appropriate
• The specific procedure being considered
• Nonsurgical alternatives
• Potential benefits
• Potential risks and complications
• Expected recovery
• Hearing rehabilitation
• Whether additional procedures may be necessary

The specific preparation and testing depend on the procedure.

What Is Recovery Like After Ear Surgery?

Recovery varies substantially depending on the operation. After middle-ear surgery, patients may experience temporary:

• Ear fullness
• Changes in hearing
• Mild discomfort
• Dizziness or imbalance
• Sensitivity around the operated ear

Restrictions can also vary. Your surgeon may provide instructions regarding keeping the ear dry, strenuous activity, swimming, air travel, and pressure changes. Hearing may not improve immediately after surgery. Some procedures require time for healing and, when appropriate, hearing rehabilitation before the final result can be assessed. Your surgeon should provide procedure-specific postoperative instructions.

Every surgical procedure has potential risks, and the risks depend on the specific operation, the patient’s anatomy, the underlying disease, and whether the procedure is a primary or revision surgery. Potential risks can include:

• Infection
• Bleeding
• Dizziness
• Taste disturbance
• Persistent or worsened hearing loss
• Tinnitus
• Facial nerve injury
• Need for revision surgery
• Failure to achieve the desired hearing improvement

For example, the American Academy of Otolaryngology–Head and Neck Surgery notes that dizziness can occur after stapes surgery and that taste disturbance may occur and generally improves over time; serious complications are uncommon but remain possible. Your surgeon should explain the procedure-specific risks and benefits before surgery.

Ear surgery can involve delicate structures responsible for hearing, balance, and facial nerve function. An otologist or otologic surgeon is an otolaryngologist with focused expertise in disorders and surgery involving the ear and hearing system.

Dr. Neil M. Sperling has focused on hearing disorders and hearing restoration since 1991. He completed a fellowship in Otologic Surgery at the Minnesota Ear Clinic and serves as Medical Director of Hearing Healthcare and Technologies in the Department of Otolaryngology at Lenox Hill Hospital. His clinical expertise includes:

• Otosclerosis
• Stapedectomy and stapedotomy
• Tympanoplasty
• Ossicular chain reconstruction
• Cochlear implantation
• Conductive hearing loss
• Sudden hearing loss
• Cholesteatoma
• Hearing restoration
• Implantable hearing devices

For additional information about Dr. Sperling’s education, board certification, academic appointments, hospital affiliations, professional memberships, publications, and teaching activities, visit his physician profile.

Dr. Neil Sperling provides ear and hearing care in Manhattan, New York City.

Midtown Manhattan

36A East 36th Street, Suite 200
New York, NY 10016

Manhattan West Side

9 West 67th Street
New York, NY 10023

Phone: 212-889-8575