Shea Ear Clinic Memphis, TN

Ear Surgeries

Stapedectomy

Stapedectomy is an outpatient operation performed under anesthesia at the Shea Ear Clinic in which the diseased stapes is removed and replaced with an artificial bone (a prosthesis) made of Teflon and platinum wire to restore the transmission of sound to the inner ear.

Stapedectomy was developed by Dr. John J. Shea, Jr. in 1956, who performed approximately 25,000 stapedectomies during his career at Shea Ear Clinic.  It is now performed all over the world and is considered the standard of care in the surgical treatment of otosclerosis, a condition in which diseased bone forms around the stapes (stirrup) bone in the middle ear, causing it to become fixed to the oval window (opening to the inner ear).  This blocks the transmission of sound to the inner ear and causes a conductive (mechanical) form of hearing loss.  Untreated otosclerosis will get worse and eventually will usually begin to affect both ears.

Good candidates for stapedectomy are patients who have otosclerosis and conductive hearing loss of at least 15-20 decibels. Often this can improve hearing to the point that a patient does not need a hearing aid.  Patients with very severe otosclerosis might still benefit from a stapedectomy, if only to improve their hearing to the point where a hearing aid can be of help. The procedure can improve hearing in more than 90 percent of cases.  The surgeons at the Shea Ear Clinic are world-renowned in their skill and experience with otosclerosis and stapedectomy.

Intratympanic Therapy/Inner Ear Perfusion

Inner ear perfusion is a procedure in which medicine is delivered to the inner ear through the middle ear, the space behind the ear drum.  A small  needle is passed through a tiny hole in the ear drum and the medicine is slowly injected into the middle ear.  This is a convenient way to give medicine to the inner ear because the inner ear is a closed chamber and is relatively difficult to gain access to.  Placing medication into the middle ear allows the medication to “perfuse” (soak into) the inner ear through a thin structure called the round window membrane, which lies between the middle and inner ears.  This procedure is performed at the Shea Ear Clinic Surgery Center with the patient awake.  The ear drum is anesthetized first and the patient is sometimes given a mild sedative intravenously, as well as intravenous steroids.  Following the injection, the patient lies with the ear up for two hours to allow the medicine to perfuse into  the inner ear.

Intratympanic therapy (perfusion) has become a mainstay of treatment for a number of inner ear conditions like vertigo, Meniere’s disease, sudden hearing loss, and even tinnitus.  It is generally recommended when more conservative measures, such as oral medication, dietary changes, and balance therapy have failed to give the patient relief.  It can be repeated as necessary, and the type of medication used is tailored to the patient’s symptoms, complaints, and hearing status.  These medications include steroids and aminoglycosides like streptomycin in varying dosages.

Dr. John J. Shea, Jr. was one of the pioneers of the perfusion treatment and did a large amount of early work on it in the 1980’s and 1990’s which helped refine it to its current state today.  Many thousands of these treatments have been performed at the Shea ear clinic over the last 20 years, and it has largely replaced more invasive procedures like endolymphatic shunt (surgically draining the inner ear to relieve pressure) and vestibular nerve section (cutting the balance nerves between the inner ear and brain) in the treatment of Meniere’s disease.

Tympanoplasty

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.

Mastoidectomy

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.

Cochlear Implantation

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.

Middle Ear Implants

Some adult patients have a hearing loss that can be helped by hearing aids, but because of chronic ear canal infections, or allergies to the materials used in hearing aids, are unable to tolerate the use of a hearing aid. Under these circumstances, patients can benefit from a middle ear implant called the Vibrant Soundbridge. A Vibrant Soundbridge has an attachment call the “floating mass transducer” which is clipped to the middle ear bones, and an internal processor that is placed on the skull, behind the ear, under the skin. An external device placed on the outer ear allows for sound to be sent to the internal processor, the “floating mass transducer” then moves the middle ear bones and the sound is amplified so that the patient can hear better. While a Vibrant Soundbridge does not restore normal hearing, patients who have been implanted can achieve the benefit of hearing aids, and avoid problems of ear canal infection and skin allergies.

During an operation, the surgeon uses a drill to remove the mastoid bone, and then enters the middle ear through an area called the facial recess. The “floating mass transducer” is then placed on to the middle ear bones, and the internal processor is then placed under the skin on the skull behind the ear. Following the healing process, the user then uses the Vibrant Soundbridge like a hearing aid.

Translabyrinthine Surgery/Surgical Labyrinthectomy

Some patients have intracranial conditions that affect balance, hearing or facial nerve function and are best addressed with a surgical approach that goes through the mastoid and inner ear or removes the inner ear. Some of those conditions are end-stage Meniere’s disease, acoustic neuromas, meningiomas, and glomus tumors.  The translabyrinthine approach involves removing the balance portion of the inner ear (the “labyrinth”) by drilling through the mastoid and inner ear to rid the patient of abnormal signals from the inner ear or to provide access to deeper structures in the skull base.

For those Shea Ear Clinic patients who would be best served by this procedure, the care is provided in collaboration with the skilled and experienced neurosurgeons of the Semmes-Murphey clinic.

During an operation, an incision is made behind the ear and the mastoid, and the mastoid air cells and inner ear structures are removed to expose and gain access to the disease process. After addressing the disease process, the opening is then closed with fat harvested via a small incision in the abdomen.  This method is used for small to large acoustic neuroma tumors in cases where hearing is not functional, and reduces the risk of brain swelling and other complications, though it sacrifices any remaining hearing and balance function in the operated ear.  Although the balance mechanism has been removed on the operated ear, the balance mechanism from the other ear takes over and provides stabilization for the patient over one to four months, easing the recovery for the many patients.

Middle Cranial Fossa Surgery

Some patients have intracranial conditions that affect balance, hearing and facial nerve function which are best addressed with an approach that goes around the middle ear and mastoid. These conditions include small acoustic neuromas, superior semicircular canal dehiscence, middle fossa encephaloceles, cerebrospinal fluid (CSF) leak, and Bell’s palsy.  The approach best suited for this situation is called the middle cranial fossa approach.

For those Shea Ear Clinic patients who would be best served by this procedure, the care is provided in collaboration with the skilled and experienced neurosurgeons of the Semmes-Murphey clinic.

During an operation, an incision is made above the ear, an opening is made into the side of the skull (a “bone window”), and the brain is elevated to expose the area that is being operated on. The middle cranial fossa approach offers the possibility of preserving the facial nerve function, hearing and balance, and every effort is made to preserve the function of these structures during surgery.  Middle cranial fossa surgery should only be performed by an experienced surgical team because of its technical difficulty.

Posterior Cranial Fossa Surgery

Some patients have intracranial conditions that affect balance, hearing and facial nerve function which are best addressed with an approach that goes around the middle ear and mastoid. Some of those conditions are acoustic neuromas, meningiomas, endolymphatic sac tumors, and glomus tumors.  One such approach is performed by going behind the ear and mastoid, and is called the retrosigmoid approach.

For those Shea Ear Clinic patients who would be best served by this procedure, the care is provided in collaboration with the skilled and experienced neurosurgeons of the Semmes-Murphey clinic.

During an operation, an incision is made behind the ear and mastoid, and the brain is retracted back slightly to expose the disease process.  Every effort is made to preserve facial nerve function, hearing and balance while still addressing the disease.  In some patients, it is necessary to sacrifice the hearing to remove the entire tumor.  This method is used for medium or larger acoustic neuroma tumors in cases where hearing in the affected ear is still functional, but carries a significant risk of headaches postoperatively. The posterior cranial fossa approach offers the possibility of preserving facial nerve function as well as hearing and balance, and should be performed by appropriately trained and experienced surgeons due to its technical difficulty.

Shea Blog

7.15.14

Smoking Cessation: Part 2

Click here to read more

7.1.14

Smoking Cessation: Part 1

Click here to read more

 


Latest News

An article was recently released which discussed Shea clinic's ground-breaking work in Memphis. Click here to read more.

Shea Ear Clinic Physicians Present Research Development. Click here to read more.