Inner Ear Surgery for Children

Dhealthwellness.com – During surgery, you will be under general or local anesthesia. The operation usually takes 2-3 hours.

Placing Dissolvable Packaging in the Ear Canal

We will lift your eardrum to reach your middle ear bones. If your ossicles are damaged, we will replace them using grafts or artificial devices. We may place dissolvable packing in your ear canal to prevent the graft and eardrum from moving while they heal. Your hearing will improve after a week or so.

Stapedectomy is an operation to replace the damaged stapes bone in the middle ear and improve conductive hearing loss due to otosclerosis. It is a relatively quick procedure and can be performed under local or general anesthesia. First, the surgeon will examine your tympanic membrane or eardrum and perform an audiometry test. This will determine the range of tones you can hear and will show whether the stapes is fixated or has visible otosclerosis deposits.

We then remove the damaged stapes and place a plastic prosthesis in its place. This prosthesis conducts sound vibrations into your inner ear and restores hearing. We often seal the surgical opening with a bit of fatty tissue taken from behind your ear canal. A rare complication of this surgery is weakness of the facial nerve. It is usually reversible with time and medical therapy. Most patients achieve improved to normal hearing with this procedure. They may need to wear a hearing aid to obtain the best results.

Surgery by Making an Incision Behind the Ear to Remove Diseased Tissue

When cells in the spongy, honeycomb-shaped bone behind your ear become infected and antibiotics fail to clear up the infection, mastoidectomy surgery may be needed. This involves removing the affected tissue and sometimes a portion of the skull bone. This operation is usually performed under general anesthesia and requires 4-7 days of hospitalization. During this procedure we make an incision behind your ear to remove the diseased tissue and to expose the balance nerve (vestibular). Sectioning of the vestibular nerve results in permanent loss of hearing in less than 5% of patients, but the symptom of vertigo is eliminated.

We may also perform a tympanoplasty during the mastoidectomy. This surgery repairs the ear drum and the parts of your inner ears that conduct sound vibrations, which restores hearing. You will have stitches and a rubber drain in your ear after this surgery. You should protect your ear from water by covering it with a cotton ball soaked in Vaseline every time you shower. The tympanoplasty (or myringoplasty) procedure closes a perforation of the eardrum. It has been used since the 1950s to reduce recurrent ear infections. It also helps to improve hearing.

After your child is sedated, the surgeon will create a small cut behind or inside the ear canal and remove any dead tissue. The surgeon then places a new eardrum (or patch) on the hole in the eardrum using either a paper graft or another piece of tissue taken from the ear canal. A tympanoplasty can be performed entirely through the ear canal (transcranial) or, if the eardrum perforation is large or located in the back of the ear, through a small incision behind the ear (the transtympanic approach). Either technique is safe and effective.

Giving Pain Relievers to Children as Needed

A follow-up appointment will be scheduled to evaluate your child’s healing. It is important that your child follow the surgeon’s care instructions. During this time, your child may have some drainage from the ear canal or mild ear pain and soreness. You may give your child pain medicine as needed. In this procedure, your child will have a mechanical microkeratome (a ring placed on the eye) or laser device which uses light to cut a flap in your child’s cornea. Your child may feel some pressure while this is done, but it is only a very short time.

This surgery repairs a hole in the middle ear drum (tympanoplasty). It also corrects any damage to the tiny bones that are important for hearing. It is often done after repeated ear infections when the eardrum becomes punctured.

It is also used to treat a condition called perilymph fistula, which happens when fluid leaks from a space between the middle ear and the inner ear. The laser can help seal this and remove the abnormal blood vessels. It can also be used to treat port-wine stains, which are a type of vascular defect. This treatment is not suitable for everyone and your child will need to be assessed before a decision is made to have it.

Reference :

Isaiah, A., Lee, D., Lenes-Voit, F., Sweeney, M., Kutz, W., Isaacson, B., … & Lee, K. H. (2017). Clinical outcomes following cochlear implantation in children with inner ear anomalies. International journal of pediatric otorhinolaryngology93, 1-6.

Buchman, C. A., Copeland, B. J., Yu, K. K., Brown, C. J., Carrasco, V. N., & Pillsbury III, H. C. (2004). Cochlear implantation in children with congenital inner ear malformations. The Laryngoscope114(2), 309-316.

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