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

ossicular chain reconstruction Case Number 3

This patient has had several ear surgeries in her past when she was a young child. Her eardrum is very lateralized—it has healed into place too far out in the ear canal. Her hearing is very poor with a large conductive hearing loss. After considering options, she elected to proceed with a middle ear exploration and assessment of her hearing mechanism.

The eardrum is noted to be laterally displaced. It is intact. There are no ossicular elements noted.

The stapes bone (black arrow) is clearly visualized once the eardrum is elevated.  There is no connection between the eardrum and the stapes, the third hearing bone.  Thus, this patient had a maximal conductive hearing loss.  The white arrow is pointing towards the facial nerve, that lies just above the stapes bone.

A close-up view of the stapes bone and the facial nerve (white arrow).  The black arrow signifies the stapedius muscle that is attached to the stapes bone and serves a functional role.  When a very loud sound enters the ear, this muscle contracts, stiffening the stapes bone and limits the amount of motion of the stapes bone and decreases potential damage to the inner ear. 

Hearing reconstruction is begun by placing a prosthesis over the stapes bone (black arrow).  This implant replaced the 2nd hearing bone, thus connecting the eardrum to the 3rd hearing bone and thus the inner ear.  This prosthesis has a titanium basket that rests on the mobile stapes bone.

A cartilage graft is taken from the tragus cartilage of the ear.  The cartilage is shaved and placed over the prosthesis and under the eardrum.  This shell of cartilage sits atop the implant, stabilizing it within the middle ear and also preventing extrusion of the implant through the eardrum.

The eardrum is then placed into position, over the cartilage graft and the prosthesis.  The black arrow shows the cartilage graft that is barely visualized through the eardrum.  Now, when sound enters the ear canal, it will vibrate the eardrum, thus moving the prosthesis that was placed on the stapes bone and allowing the patient to hear. 

Hearing Reconstruction Procedure Cases

Dallas Ear Insittute

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