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Treatments

An operation is one option among several. Each page states the objective of the procedure, what may improve, what must be protected, and the alternatives — the same seven questions every time.

The surgical decision — the framework used on every treatment page

Seven questions every recommendation should answer

  1. Problem

    What is wrong?

    A precise diagnosis of what is wrong, confirmed by examination, audiometry and, where needed, imaging.

  2. Objective

    What are we trying to achieve?

    A clear statement of what treatment is meant to achieve: a safe ear, better hearing, less device dependence, or a combination.

  3. Expected benefit

    What may improve?

    A realistic estimate of the improvement that may follow — and the probability of no improvement.

  4. Alternatives

    What other options exist?

    Observation, hearing aids, bone-conduction devices, implants or a different operation.

  5. Preservation

    What existing hearing must be protected?

    The inner-ear hearing, bone-conduction thresholds and the future options that must not be compromised.

  6. Risk

    What are the relevant trade-offs?

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

  7. Personal priorities

    What matters to this individual?

    What matters most to this person: independence from a device, avoiding any risk to the better ear, work, music, time.

Treatment Ear surgery An overview of middle-ear surgery — stapedotomy, tympanoplasty, ossiculoplasty, cholesteatoma and revision — with the seven questions every recommendation should answer. Treatment Stapedotomy Stapedotomy for otosclerosis: what the operation does, the small-fenestra technique, expected hearing results, risks, recovery, flying, revision and alternatives. Treatment Tympanoplasty What tympanoplasty involves, how the eardrum is repaired, what it does for infection and hearing, and why a dry ear and a better-hearing ear are separate objectives. Treatment Ossiculoplasty How the ossicular chain is reconstructed after erosion, fixation or discontinuity, which prostheses are used, what hearing gain to expect, and where the limits lie. Treatment Revision ear surgery Why ear operations disappoint, the causes of a poor or fading result after stapes, ossicular or eardrum surgery, and why reassessment must precede any second operation. Treatment Hearing rehabilitation Hearing aids, bone-conduction devices, middle-ear implants and cochlear implants — the device-based routes to better hearing and when each is the right answer.