Behind the ear drum, there are 3 ossicles, which are media for transmitting the sound waves towards the inner ear & then to the brain. These ossicles are :
It is 3rd ossicle, stapes which gets fixed by new bone deposition around its footplate hampering the mobility of the ossicle & by this causing conduction blockage in sound waves, resulting in hearing loss.
1. Hearing loss (deafness) (One sided/Both sides).
2. No Ear discharge (Otorrhea).
Treatment is purely surgical.Fixed Stapes ossicle is removed & then replaced by a few Teflon prosthesis (piston), procedure called Stapedotomy; done under (L.A.) Local Anaesthesia.
Patient starts hearing immediately on the operation table itself.
No external incision is seen; neither any suturing is required.
2.Chronic Suppurative Otitis Media (CSOM)with Perforation(View Details)
Recurrent discharge from the ear more especially after the common cold attack (Otorrhea).
Decreased Hearing (Deafness)
Occasionally Ear Pain
Occasionally Giddiness (Vertigo)
URTI (Upper Respiratory Tract Infection)
Tonsillitis & Adenoid Hypertrophy in children.
Grafting of the perforated ear drum, using patient's own Temporalis Facia as a graft material; procedure called Tympanoplasty; done under L.A.(Local Anaesthesia)/ G.A.(General Anaesthesia), under the microscope.
Future complications, If surgery is delayed/not done :
1. Recurrent ear discharge (Otorrhea).
2. Gradual & Permanent hearing loss (Deafness).
3. Giddiness (Vertigo).
CARTILAGE TYMPANOPLASTY (OSSICULOPLASTY)
Cartilage is a flexible connective tissue found in many areas in the bodies of humans, including the joints between bones, the rib cage, the ear and the nose. It is not as hard and rigid as bone but is stiffer. In other words we can call it a Soft Bone. Cartilage used for Ossiculoplasty is harvested from tragus part of the patientís own ear.
It is a surgical procedure, where perforated ear drum (tympanic membrane) is reconstructed using temporalis facia (Soft tissue layer above the temporalis muscle)
Ossiculoplasty (reconstruction of ossicular chain behind the tympanic
Sometimes, ossicles (1. Malleus 2. Incus 3. Stapes) present in the middle ear, behind the tympanic membrane, are necrosed, due to the Disease in the middle ear; resulting in more deafness to the patient, apart from already which patient has due to the perforation in the middle ear.
Restoration of the continuity between these 3 ossicles, is called Ossiculoplasty.
There are very few centres in the world, where Cartilage Ossiculoplasty (ossiculoplasty, using patientís own cartilage) is done; our centre is one of them; our 21 yrs. Patientís follow up study of cartilage ossiculoplasty acceptance success rate is 100%, used in around more than 5000 patients.
After reconstruction of the perforated ear drum with temporalis facia, if ossicles too need to be reconstructed, patient gets better hearing.
There are other prothesis too which are used world-wide for ossicular reconstruction purpose; they are called:
TORP Ė Total Ossicular Replacement Prosthesis
PORP Ė Partial Ossicular Replacement Prosthesis
They are made of Titanium or Gold Metals.
COMPARISON CHART OF CARTILAGE & METAL PROSTHESIS
(Titanium & Gold)
Patientís own material hence acceptance rate is 100%
Itís a foreign body, hence there are chances of rejection, rate of rejection varies from patient to patient and from one Surgeon to another Surgeon.
Being a Soft material, there are almost no chance of damage to the Inner ear, even in long term; therefore very safe as far as Inner ear hearing safety is concerned. Any amount of Inner ear hearing loss due to Prosthesis is irreversible & permanent.
Being a Solid material, post operative ear cleaning, Sometime accidentally may directly transmit excessive vibrations to the inner ear, there by causing permanent Inner-ear (Sensory neural) hearing loss.
Cartilage Ossiculopasty can be combined in a single sitting (surgery) along with the Tympanoplasty; It means only one surgery is required (Single Stage)
Can not be done with the Tympanoplasty in the same sitting, because of very high chances of rejection of the prosthesis. 2nd Surgery is always required.
Prosthesis is Cost effective.
Cartilage Ossiculoplasty needs very high degree of precision and skill, It is customized for each of the patient, measurements are in micro-milimeters, hence only very few centres in the world are skilled for this procedure.
Metal Prosthesis are ready to fit and are very easy to use.
Cholesteatoma is an unsafe type of Chronic Suppurative Otitis Media (CSOM) It is nothing, but squamous epithelium(Skin) trapped within the bony cavities of different parts of the ear, which has the great potential to cause wide spread bone destruction & necrosis around it; & hence causing severe complications mentioned below.
1. Foul smell Ear Discharge (Otorrhea).
2. Hearing loss (Deafness).
Warning Symptoms :
2. Otalgia (Ear Pain)
3. Vertigo (Giddiness).
4. Blood Stained Ear discharge (Otorrhea).
Treatment is 100% surgical. Surgery is called Tympano-Mastoidectomy which is done under microscope; where diseased mastoid bone is drilled out & cholesteatoma is removed & finally reconstruction of the typmanic Membrane & hearing Ossicles is done.
Future complications, if surgery is delayed/not done :