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Conductive Hearing Loss


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Commonly called eardrum repair, Tympanoplasty refers to a surgery performed to reconstruct a perforated tympanic membrane or small bones located in the middle ear. Eardrum perforation may be due to severe infections or from trauma to the eardrum. Perforations occur as a result of defects in elastic collagen fibres. Small perforations heal by themselves spontaneously. But if the damage is severe as in the case of a trauma, a slap in the ear or an explosion, spontaneous healing may not occur and surgical intervention may be required to rectify the defect.

Tympanoplasty is performed to repair a perforated eardrum and occasionally the middle ear bones. Tympanic membrane grafting is required where tissue on the lobe of the ear or synthetic materials may be used for this purpose. The surgery may be performed under local or general anaesthesia. During the surgical process, an incision is made in the ear canal. The ear drum is lifted forward so as to enable viewing through a microscope. If the perforation is large or the hole is not visible, an incision is made behind the ear. Once the hole is located, the perforated area is rotated forward, bones are checked and dead tissues are removed. For grafting, tissues are taken from the lobe of the ear or a vein, thinned, dried and inserted underneath the remaining unaffected portion of the eardrum. Care is taken to ensure that the perforation is closed. Very thin layer of tissues are placed on top of the graft to prevent it from sliding. All the incisions made are sutured and the ear is dressed.

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Ostosclerosis, a common cause of hearing impairment, is a disease of the middle ear bones and occasionally, the inner ear. Stapedial Ostosclerosis is a kind of conductive hearing impairment in which the stapes, a bone in the middle ear, fails to vibrate correctly in response to sound waves. This is because of abnormal hardening of the bone and is corrected through surgery. The operation, performed under local or general anaesthesia, involves making a small incision behind the ear to remove a tissue for later use during surgery. The eardrum is elevated, the bones are palpated and ostosclerosis is confirmed by observing through a microscope. The stapes is vapourized, and hardened parts are removed. Through a small opening in the footplate of the stapes, a stainless steel or platinum implant is used to connect the stapes to the incus. The eardrum is then restored to its position. The implant now allows sound vibrations to pass from ear drum to the inner ear fluids.

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These are helpful if the hearing loss is mild. It is also advised if the patient is not in a position to undergo a surgery. Hearing aids increase the loudness to forcefully allow sound to enter through the blocked middle ear. Hearing aids differ by design and technology used. They may be placed behind the ear, on the ear, in the ear or completely inside the ear canal. The specialist is the right person to determine the right type to be used.

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This is a type of hearing aid based on bone conduction. This is recommended for people who cannot use conventional hearing aids. It requires a minimal invasive surgery through which a titanium implant is placed inside the skull. A small abutment is placed outside the skin that transmits sound vibrations to the implant. These are highly effective in restoring hearing capacity.

Authored by Dr Shailesh Pandey, ENT Specialist

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