Hearing Aids Hearing Loss Pediatric Hearing Loss Tinnitus Surgical and Implantable Hearing Correction

ossicular chain reconstruction Case Number 2

This 30-year-old patient presented with a hearing loss in his left ear that he had noted since he was a child.  He recounted a history of multiple ear infections and head trauma to the left side as a child, and a severe hearing loss in the ear for many years.  Upon exploring his middle ear, he was found to lack the incus and stapes hearing bones (the 2nd and 3rd hearing bones), and this explained his severe hearing loss.  In addition, he was found to have a significant dehiscence of his facial nerve—the bone that typically covers his facial nerve (the nerve supplies all of the muscles of the face) was completely gone and the nerve was exposed.  The nerve was not disturbed, and his hearing was completely restored by reconstructing the ossicular chain.

1) The eardrum looks completely normal and healthy.  As you can see, the first hearing bone (black arrow) is attached to the eardrum, as is the case in normal ears.

2) The eardrum has been elevated and a view of the middle ear is obtained.  Access is gained to the tiny hearing bones of the middle ear by making a small incision in the ear canal and lifting the eardrum forward.  The blue arrow signifies the chorda tympani nerve, which is a taste nerve that runs through the middle ear.  This nerve is not disturbed during this surgery.  The black arrow is pointing towards the remnant of the incus, or 2nd hearing bone.  This bone has been nearly completely eroded—the only part that is left of the bone is the head of the incus, which the black arrow is pointing towards.  The white arrow is pointing towards the stapes footplate.  In a normal ear, the stapes bone (3rd hearing bone that is shaped like a horseshoe) sits on top of this plate that separates the middle ear from the inner ear.  Motion of this bone on this footplate allows us to hear.  In this case, the bone is completely gone and there is no connection between the eardrum and the inner ear.  Lastly, the facial nerve that runs above the stapes footplate lacks the bone that typically covers this nerve.  The yellow arrow indicates a “knuckle” in the nerve that is protruding down.

3) This image shows the facial nerve and the dehiscence, or exposure, of the nerve in the middle ear cavity.

4) This is a prosthesis that will reconnect the eardrum and the inner ear, allowing hearing recovery.  This is trimmed to the correct size and placed in the middle ear to re-establish the normal function of the ear. 

5) The prosthesis is placed from the malleus, or 1st hearing bone, to the footplate of the inner ear.  Now, movement of the eardrum from sound will vibrate the footplate and allow hearing to occur.

6) The eardrum is replaced.  A faint shadow of the prosthesis is visible through the eardrum (black arrow).  This prosthesis will stay in place and should afford hearing for the rest of the patient’s life.

Hearing Reconstruction Procedure Cases

Dallas Ear Insittute

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