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Treatments

Ear surgery

An operation is one option among several. Before asking how to operate, ask whether operating offers the best balance of benefit and risk for this ear and this person.

Where ear surgery helps

Surgery of the ear can do a limited number of things well. It can close a hole in the eardrum, remove disease from the middle ear and mastoid, rebuild or bypass the ossicles, and place devices such as bone-conduction and cochlear implants. What it cannot do is repair a damaged inner ear; hearing loss of cochlear origin is treated with devices, not scalpels.

The operations described on this site are those of the middle ear:

  • Stapedotomy — bypassing a stapes fixed by otosclerosis.
  • Tympanoplasty — repairing the eardrum, with or without work on the ossicles.
  • Ossiculoplasty — reconstructing the chain of three bones.
  • Cholesteatoma and mastoid surgery — removing skin disease to create a safe ear.
  • Revision ear surgery — re-operating after a previous procedure, which should begin with revising the diagnosis.
  • Hearing rehabilitation — the devices that are frequently the better answer, or the necessary complement.

Education, assessment, opinion, treatment, referral

These are different things and this site tries to keep them apart. The pages here are education. An assessment requires a history, examination and tests. A second opinion reviews an assessment and a proposed plan. Treatment happens in a clinic under local regulations — for consultation in France see grolman-orl.fr. Where a procedure is described but not personally offered, the page says so and points towards referral.

What “success” should mean

An operation can be a technical success and a personal disappointment. A closed air-bone gap measured in a soundproof booth matters; so does hearing a colleague in a noisy meeting, and so does whether a hearing aid is still needed. The functional outcome model below is used throughout the treatment pages to keep all three levels in view.

The surgical decision

Seven questions every recommendation should answer

  1. Problem

    What is wrong?

    Conductive or mixed hearing loss, discharge, perforation or disease in the middle ear — identified precisely by examination, audiometry and imaging where needed.

  2. Objective

    What are we trying to achieve?

    One or more of: a safe ear, a dry ear, better sound transmission, less dependence on a device. Each is stated separately.

  3. Expected benefit

    What may improve?

    A realistic estimate of hearing gain in decibels and in daily function, and the probability that hearing does not improve.

  4. Alternatives

    What other options exist?

    Observation with repeat testing; hearing aids; bone-conduction devices; middle-ear or cochlear implants; a different or staged operation.

  5. Preservation

    What existing hearing must be protected?

    Inner-ear hearing, bone-conduction thresholds, the better ear, and the options that may be needed later.

  6. Risk

    What are the relevant trade-offs?

    Worse hearing, dizziness, tinnitus, taste change, facial-nerve injury, graft failure, need for revision — with frequencies where the evidence allows.

  7. Personal priorities

    What matters to this individual?

    What this person wants from their hearing: work, music, family conversations, independence from devices, avoiding any risk to the better ear.

How should success be measured?

A closed air-bone gap is a good result on paper. Whether it is a good result for the person depends on what happens outside the test booth.

Audiometric

What the test booth measures

  • Air conduction
  • Bone conduction
  • Air-bone gap
  • Speech audiometry

Functional

What the auditory system can do

  • Speech understanding
  • Hearing in noise
  • Localisation
  • Binaural hearing
  • Listening effort

Real world

What changes in daily life

  • Communication
  • Work
  • Social participation
  • Hearing-device dependence
  • Quality of life
  • Patient priorities

This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.