Bilateral Myringotomy (Tympanostomy) Tubes (BMT)
BM-T is a surgery to treat children who have otitis media (oh-TITE-us MEE-dee-ya) or middle ear infections that won’t go away with medication; middle ear fluid that won’t go away; or hearing loss or speech delays caused by frequent ear infections.
- In a BM-T, the surgeon will put small tubes in your child’s eardrums to allow air to get inside. When air is able to get behind the eardrum, the fluid inside the ear can flow out or dry up, taking away the pain or pressure your child may have been feeling and making future infections less likely.
- An ear tube is made of plastic and looks like a tiny spool. More than 25 of them could fit on the face of a dime. They are so small that you usually cannot see the tubes just by looking into your child’s ear.
- In most cases, ear tubes do not need to be removed and usually are pushed out on their own after about 6 to 18 months, as the eardrum heals. If a tube remains in the eardrum for more than 2 or 3 years, however, it may need to be removed by your doctor.
Tympanoplasty is an operation to repair the ear drum when it is not working correctly or when there is a perforation (hole) in it, usually from infection, a ventilation tube, or sometimes from trauma. This may also include repair of the tiny bones in the middle ear, called ossicles (the hammer, anvil, and stirrup). The operation is performed at the Shea Ear Clinic Surgery Center as an outpatient with the patient under anesthesia. It may be performed completely through the ear canal, with no external incision, or through an incision in the crease behind the ear. Which route is used will depend on the size and shape of the ear canal and location and size of the perforation. Sometimes mastoidectomy (removal of the bone and air cells behind the air which may harbor infection) is performed at the same time as tympanoplasty. Either way, the goal is to leave the patient with a “safe” ear, if possible (one that does not drain and is impervious to water) and to hopefully restore hearing as much as possible. Recovery takes a few days to a week in some cases and most patients can return to school or work within this time frame. Results are generally good, with at least 80-90% success in most cases.
The mastoid refers to the bony air cells that are behind the ear canal. Their role is not completely understood, though they may help keep the middle ear space filled with air, and act as a resonance chamber to help us hear. In some, these air cells can develop an infection, mastoiditis, which does not respond to antibiotics, and surgery is necessary to address the infection. In other cases, a mastoidectomy is performed in order to place hearing devices such as a cochlear implant. The surgery that is performed to open and remove those air cells is called a mastoidectomy.
During an operation, the surgeon uses a drill to remove the bone and underlying air cells to remove infection or disease, or provide access to the inner ear in order to place a cochlear implant. In some cases of infection or cholesteatoma (abnormal cyst of trapped skin cells), it is necessary to remove the posterior ear canal wall, which will combine the ear canal and mastoid into a mastoid “cavity”. This is known as a “canal wall down mastoidectomy”. The mastoid cavity helps reduce the likelihood of recurrent infection and cholesteatoma, and frequently the middle ear bones can be reconstructed to improve hearing as well. In some cases, the patient will require periodic visits to an otologist to clean debris from this cavity, which can be done during a clinic visit.
Ossicular Chain Reconstruction
The middle ear houses three very small bones, or ossicles, called the malleus (hammer), the incus (anvil), and the stapes (stirrup). These bones conduct sound from the tympanic membrane (ear drum) to the inner ear, amplifying it at the same time. Sometimes the ossicles do not work properly, because of disease or trauma, which leads to a “conductive” hearing loss, or loss of hearing due to lack of effective sound transmission into the inner ear. This type of hearing loss can often be improved through surgery, as opposed to sensorineural hearing loss (nerve deafness), which usually cannot. When a hearing loss occurs, a procedure called an “ossicular chain reconstruction” can help restore some or most of the hearing.
Ossicular chain reconstruction refers to the rebuilding of the connection from the tympanic membrane (ear drum) to the stapes bone. This can be done as a single procedure, or can be combined with a tympanoplasty and mastoidectomy. By using a prosthesis (artificial ear bone), the connections are restored in a manner to mimic the original mechanism. The prosthesis can be made of ceramic, metal, plastic, or several different materials combined together, depending on the extent of reconstruction needed.
In some cases of infection or cholesteatoma, the ossicular reconstruction is delayed, and a “second look” surgery is done at a later point in time to determine if the ear is healthy enough for ossicular chain reconstruction.
Some patients, both children and adults, have hearing loss in both ears that is too severe to be helped by hearing aids. Many of these patients can benefit from a cochlear implant. A cochlear implant consists of two parts, an internal component and an external component. The internal component is surgically implanted and has an electrode that is placed into the inner ear (cochlea) and a receiver that is placed into a pocket under the skin behind the ear. The external component is the processor, and it is worn on the back of the external ear. The external component picks up sound and converts it into signals that are then sent across the skin to the internal component, which sends them through a wire into the inner ear (cochlea). The hearing nerves are connected to the cochlea, and they pick up these signals and relay them to the brain, where they are perceived as sound. While a cochlear implant does not restore normal hearing, patients who have been implanted can, with time and practice, understand spoken word, follow conversation, and hear music.
During the outpatient operation for cochlear implantation, the surgeon makes an incision behind the ear, uses a drill to remove the mastoid bone, and enters the middle ear through an area called the facial recess. The electrode is placed through the facial recess into an opening created in the cochlea, and the receiver is then placed into a pocket under the skin on the skull behind the ear. Following surgery there is a waiting period while the incision heals and swelling goes down. After a few weeks, the patient is seen by an audiologist who activates the cochlear implant, at which time the patient will be able to hear with it. Some patients hear remarkably well, even on a telephone, as soon as their implant is activated. Others may need longer to get used to the new sound patterns they are hearing. Over the next few weeks to months following activation, the patient goes back to see the audiologist for additional programming sessions that will fine-tune the performance of the implant. Eventually, the patient learns to associate the sounds with words, which with time and practice will lead to natural sounding and functional speech recognition and word understanding.
Cochlear implantation is a true “miracle of modern medicine” and has profoundly changed the lives of hundreds of thousands of patients all over the world who are deaf and were formerly able to communicate only through lip reading or sign language. It is approved for use in children down to one year of age in the United States and has allowed children born deaf to develop completely normal speech and language so that they are able to enter a mainstream school environment. Its importance and significance in modern otology cannot be overstated. The physicians at the Shea Ear Clinic will used specialized tests to determine whether you or your family member are a candidate for a cochlear implant.
Bone Anchored Hearing Aids (BAHA)
Some patients, both children and adults, have a hearing loss that is difficult to help with hearing aids because of changes to the inner ear, middle ear, middle ear bones, ear drum or ear canal. A bone anchored hearing aid (BAHA) can help by bypassing the normal hearing mechanism, and send the sound through the bone of the head directly to the cochlea (inner ear). A BAHA consists of a titanium post that is surgically placed into the bone behind the ear, to which a specially designed hearing aid is attached. While a BAHA does not restore normal hearing, patients with a BAHA can have the benefit of hearing aids, even if their inner ear, middle ear, middle ear bones, tympanic membrane or ear canal has changed.
During the outpatient operation, the surgeon uses a drill to place the post into the bone behind the ear through a skin incision. Often some of the soft tissue under the skin is also removed to reduce problems from the post irritating the skin. Following the healing process, the user snaps the specially designed hearing aid onto the post, and the sound travels from the hearing aid, through the post and the bone, into the inner ear, allowing the person to hear. The person can easily remove the BAHA from the post any time they like, and the post can be partially covered by hair, making it less noticeable.