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Surgical Management

Managing disorders of the ear and temporal bone will at times require surgical treatment for effective cure.

Tympanoplasty: Tympanic membrane perforations, significant scarring of the middle ear and eardrum, neoplasms, and cholesteatoma of the middle ear are a few of the problems that we are able address through tympanoplasty. Tympanic membrane repair may be achieved through either a lateral graft technique or an underlay technique. We perform the majority of cases through a post-auricular approach, though trans-canal procedures are possible in selected individuals.

Ossicular chain reconstruction: The middle ear bones are subject to damage, dislocation, and fixation by a variety of processes. Reconstruction of the conductive hearing mechanism is an important aspect of aural rehabilitation for many individuals.

Mastoidectomy: Surgery of the mastoid portion of the temporal bone is required for a variety of infectious and neoplastic processes.

Tympanoplasty with mastoidectomy: Chronic ear infection, cholesteatoma, and neoplasia are common disease processes affecting both the middle ear and mastoid bone. Oftentimes, surgery must address both the middle ear and mastoid bone through this combined approach.

Canalplasty: Congenital or acquired narrowing, chronic infection, exostoses, and neoplasia of the ear canal may benefit from this procedure to enlarge and modify the shape of the ear canal. Split thickness skin grafting may be necessary to help line the newly formed canal.

Stapedectomy/Stapedotomy: Otosclerosis is a common cause of conductive hearing loss in adults that may be addressed surgically through either stapedectomy or stapedotomy. We generally perform this procedure through a trans-canal approach under local anesthesia.

Cochlear Implant surgery: Children and adults with severe to profound hearing loss resulting from any of a host of causes may benefit from placement of a cochlear implant. This procedure involves delicate placement of an electrode within the cochlea.

Bone-anchored hearing aid placement: Individuals with single-sided deafness, conductive hearing loss, or mixed hearing loss may benefit from placement of a bone-anchored hearing aid. This procedure can generally be done under local anesthesia and is approved for use in patients five and older.

Surgery for Meniere’s disease: Individuals with Meniere’s disease suffer disabling vertigo. We offer a number of surgical therapies designed to decrease vertiginous symptoms. These include trans-canal and trans-mastoid labyrinthectomy, retro-labyrinthine vestibular nerve section, and trans-labyrinthine total eighth nerve section.

Surgery for dizziness: Similar to those with Meniere’s disease, individuals with incapacitating dizziness (of various etiologies) may benefit from surgical intervention. Trans-canal and trans-mastoid labyrinthectomy, retro-labyrinthine vestibular nerve section, and trans-labyrinthine total eighth nerve section may be indicated in these patients as well. Also, patients with superior semicircular canal dehiscence syndrome may benefit from a middle fossa craniotomy to plug and seal the exposed canal. Finally, patients with incapacitating benign paroxysmal positional vertigo may benefit from posterior canal occlusion.

Surgery for acoustic neuroma (vestibular schwannoma): These benign tumors of the vestibular nerve may be treated surgically through one of three approaches: trans-labyrinthine craniotomy, middle fossa craniotomy, and retrosigmoid craniotomy. These procedures are performed in conjunction with our neurosurgical colleagues.

Radiotherapy for acoustic neuroma (vestibular schwannoma): Focused radiation may also be used to treat growing vestibular schwannomas in some individuals. Single- and multiple-session treatments are both available.

Surgery for glomus tumors: Glomus tumors of the middle ear, mastoid, and jugular bulb are managed through various approaches. Pre-operative embolization and angiography may be required depending upon tumor size and location as well as patient symptomatology.

Radiotherapy for glomus and other skull base tumors: Focused radiation may also be used in select patients to treat glomus tumors and other skull base tumors that demonstrate growth.

Surgery for temporal bone and skull base tumors: We treat tumors involving the temporal bone, base of the skull, and cranial nerves. These may include adenocarcinomas, squamous cell carcinomas, meningiomas, schwannomas, epidermoids, and chondrosarcomas. Multiple surgical approaches may be employed. These procedures are often performed in conjunction with our neurosurgical colleagues.

Surgery for disorders of the facial nerve: Hemangiomas and schwannomas of the facial nerve, traumatic and idiopathic facial nerve injury or paralysis, and hemi-facial spasm may benefit from surgical intervention. Trans-mastoid, middle fossa, translabyrinthine, and other skull base approaches or combination of approaches may be required to treat these challenging disorders.

Download a list of ear disorders.