Surgical procedures for the ears can significantly improve your hearing abilities, repair parts of the ear that have been damaged by trauma or infections, and even fix structural problems. Don’t miss this episode of the audio blog, we spoke to otologist, Dr. Joseph Chang, and he explained the surgical options to repair hearing.
Shelby Stockton
Welcome to the Texas ENT audio blog. I'm your host, Shelby Stockton, and today I had the opportunity to sit down with otologist, Dr. Joseph Chang, to discuss ear care and hearing loss. Dr. Chang explains how the ear works for hearing and the different types of hearing losses. He also points out what surgeries are available and educates us on hearing devices.
Shelby Stockton
Dr. Chang, thank you for spending time with me today.
Dr. Joseph Chang:
Well, thanks for having me, Shelby
Shelby Stockton:
You've got it. So this month we're focusing on ear care, ear conditions, and treatment. Dr. Chang, can you tell me how does the ear work for hearing?
Dr. Joseph Chang:
Yes. So the ear has a couple of different parts. The part that you can see on the outside is called the external ear, and that collects the sound. And then there's something called the middle ear. That's the eardrum and everything behind it. There are three little bones of hearing that conduct the sound from the eardrum to the inner ear, and these bones have to be moving and be intact for this part to work and the eardrum has to be intact for it to work. And then the inner ear has the cochlea, which is the inner ear hearing organ, and the nerve that goes from the cochlea to the brain. So that carries the signal from the inner ear to the brain, and that's how you perceive sound.
Shelby Stockton:
What are the different types of hearing loss and what causes them?
Dr. Joseph Chang:
So there are two basic types of hearing losses that we can sort out using the hearing test. There's one called the sensorineural hearing loss or the inner ear hearing loss. Those are the most common types that may be caused by noise exposure or age related hearing loss. And those are typically not correctable with surgery, but there are some treatment options for those.
For the second type is called a conductive hearing loss, where there's something wrong with structures of that middle ear or the external ear. So external ear problems could be just wax, and that's easy. You just take it out. You can have a hole in the eardrum from infection or trauma. You can have hearing bone problems of the middle ear. Those are the three little bones that conduct the sound. They could be disconnected or they could be stuck. There are various conditions that can cause that, including trauma and ear infections as well as some genetic forms where the bone gets stuck over time by itself due to calcifications. So those are all potentially fixable with surgery.
Shelby Stockton:
So then how do you treat hearing loss?
Dr. Joseph Chang:
So for the conductive hearing loss, you have a choice of either hearing aid. Those are the hearing devices that you get from the audiologist, and Texas ENT provides those for our patients. The other option for conductive hearing loss is surgery, and there are various surgeries depending on what the problem is. For example, if you have a hole in the eardrum, you can have something called a tympanoplasty that repairs the hole. It's an outpatient procedure. And once the hole heals, most of the time, the hearing can be restored.
The second thing is the problem with the hearing bones. So if they're eroded or they are stuck, you can either jiggle them loose if they're stuck, or if there's a missing piece, you can replace it with a titanium implant. And once we've reconnected the eardrum to the inner ear with a titanium implant, then that often improves the hearing.
There's another procedure called stapedectomy, which is a specific treatment for a particular type of ossicular chain problem called otosclerosis, and that only affects the states bone, which is the smallest bone in the body. And that's connected to the inner ear and that calcifies over time. And that's fixed with a procedure called stapedectomy where you take that stapes bone out. That's why it's called stapedectomy - ectomy means removal, and then you replace that with a titanium implant, and that often restores the hearing. So those types of things can be done.
There's another device called the bone anchored hearing device that can be used in people where you can't really reconstruct it and they don't want a hearing aid. Those are implants behind the ear where the sound goes right into the skull, and it turns out the skull transmits sound very easily to the inner ear. So you don't even have to have the ear canal or the middle ear for it to work. So this is great for people who are born with no ear on the outside, and they can have really good hearing with these, or those with the conductive hearing loss, where you really can't fix the conductive hearing loss for some reason. The bone anchor device will still work. So those are the options.
Shelby Stockton:
Wow. What are some other options for patients with hearing loss?
Dr. Joseph Chang:
So, the other type of hearing loss, called the sensorineural hearing loss, that is where the cochlea or the nerve to the brain is not working properly. And those cannot be fixed directly yet, so you'll need some kind of device for that. The most common thing, as I mentioned before, is a hearing aid. So people with the nerve or inner type of hearing loss can get hearing aids in most cases, and that will work just fine.
There are some patients where the hearing loss is so severe that the regular hearing aids do not work. In those patients, you can look into some implantable devices, and the first type is called a middle ear implantable device. And that actually transmits the sound from the outside, but not like a hearing aid. A hearing aid puts sound from the outside and just makes it louder into your ear. These implantable devices will change that sound signal into a mechanical signal, and it actually moves the little middle ear bones, and that's how you can hear. And because of the way it works, you can have much better amplification or much louder sound to the inner ear compared to just the regular hearing aid that only can put sound in.
Shelby Stockton):
Wow, thanks so much, Dr. Chang. This is a lot of really great information about the ear.
Dr. Joseph Chang:
There's one more thing.
Shelby Stockton):
Yes.
Dr. Joseph Chang:
So for those where the hearing is so bad you're almost deaf, people with that kind of condition can also be helped with something called a cochlear implant. So the cochlear implant is somewhat different than the other devices, because it is an electronic hearing device. So it takes a sound and it puts an electrical signals right into the cochlea. So it's kind of a bionic ear kind of thing. So this is also an outpatient surgery that you can do, and then you get it turned on. It takes some time for you to get used to the sound, because they don't sound normal initially, but this has been fantastic for people who are really so hard of hearing that they can't use any other device.
Shelby Stockton:
Thanks Dr. Chang. This has been really educational.
Dr. Joseph Chang:
It's my pleasure, Shelby.
