Laser Ear Surgery and Ear Implant Surgery

written by Dr Arasa Raj Sinnathuray on 13 March 2013
Laser Ear Surgery and Ear Implant Surgery
 
Laser Ear Surgery
 
(1) Cholesteatoma / Granulation disease (Chronic Middle Ear Disease)
The laser can remove disease from the middle ear and mastoid without causing movement of the middle ear  
   bones.  This helps avoid inner ear injury.
The laser helps stop bleeding which is very important due to blood obstructing key landmarks such as the facial
   nerve.
It can work around corners in the middle ear and hence allow removal of disease without mutilating surgery to gain  
  access.
Disease can be removed by lasering the surface of the middle ear bones without any actual hazard to them.
 
(2) Otosclerosis (Fusion of the 3rd Middle Ear bone (Stirrup) to the Inner Ear)
 
The laser helps atraumatically remove the 3rd Middle Ear bone (Stirrup) hence lowering the risk of inner ear injury.
It stops bleeding hence facilitating piston insertion to restore movement of the Middle Ear bones.
 
(3) Other ear conditions
 
It reduces bleeding which is useful in excision of vascular tumours.
It helps atraumatically vaporise scar tissue in the middle ear, which in turn reduces scar tissue reformation.  This
   reduces the chance of chronic middle ear infection + delivers better hearing.
 
 
 
 
Ear Implant Surgery
 
ACTIVE IMPLANTS (battery powered)
 
Cochlear Implant
 
Indications: Severe to Profound Sensorineural Deafness.
 
This is a semi-implantable device as although the implant is under the skin, the microphone and processor are outside the skin, communicating with the internally implanted prosthesis via a magnetic interface.  A cochlear implant in one ear is recommended for anyone with severe to profound deafness if they do not get enough benefit from hearing aids. Cochlear implants in both ears are recommended for the following groups:
children
adults who are blind or have other disabilities which mean they depend upon hearing sounds for spatial awareness
 
Middle Ear Implant
 
Indications: Mild to Severe Sensorineural Deafness, or Moderate to Severe Mixed Deafness (Conductive + Sensorineural Deafness).
 
For adults with sensorineural deafness or mixed deafness a hearing aid blocks the ear canal to varying extents creating an occlusion effect which can be uncomfortable.  If the opposite exists and the hearing aid is not tight enough it results in whistling feedback.  These side effects are overcome by the Middle Ear Implant because the ear canal is left open.  For adults or children with mixed deafness a hearing aid can also create ear discharge problems if there is chronic ear canal infection / dermatitis, or if there is already a mastoid cavity.  Also a hearing aid cannot be used at all if there is no ear canal present.  With the Middle Ear Implant because the ear canal is bypassed, so are these problems, as it is attached to the middle ear bones or directly to the cochlea.  The semi-implantable Vibrant Soundbridge device is implanted under the skin, with an external combined microphone and processor (a slim circular discreet device) held by a magnetic interface.
 
Bonebridge Implant
 
Indications: Conductive Deafness or Mild Mixed Deafness (Conductive + Sensorineural Deafness). Severe to Profound Sensorineural Deafness in one ear with normal hearing in the other.
 
This is a semi-implantable device as although the implant is under the skin, the combined microphone and processor is outside the skin.  It uses a similar slim circular discreet combined external microphone and processor as the Vibrant Soundbridge Middle Ear Implant, which communicates with the internally implanted prosthesis via a magnetic interface.  The implant itself is completely covered by skin and vibrations are directed towards the skull.  For conductive deafness or mild mixed deafness the implant stimulates the cochlea on the ‘bad’ side, same side as it is implanted.  In severe to profound sensorineural deafness in one ear with normal hearing in the other the implant stimulates the cochlea on the ‘good’ side, the opposite side to which it is implanted.  This helps overcome the head shadow effect, hearing in noise and sound localisation disabilities suffered by those with single-sided deafness.
 
PASSIVE IMPLANTS (non-battery powered)
 
Replacement of the middle ear bones.  Allows hearing improvement without a hearing aid and hence the ear canal is left open.