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Tymponoplasty Wasn't Successful, A Hole In Ear Drum Is Open, Still Have Conductive Hearing Loss. Still Fear Open Surgery?

Posted on Fri, 15 Jun 2012

Question: Name-Rajesh XXXXXXX
Age-32 years
Weight-85 Kg
Height-170 cms
When I was 8, operated adenotonsilloctomy & tymponoplasty. but tymponoplasty didn't success, and a hole in my ear drum remains open. At 8.5 Years again operated for adenoids and tymponoplasty, but this time also tymponoplasty did not success in right ear. Doc advised that it will cure it self while growing and show at age of 15. Till age of 15, right ear keeps on running pus and at age of 15, right ear mustoiductomy followed. I have still conductive hearing loss in both ears (loss of 50-60%). Yesterday an ent specialist at XXXXXXX health care India, told me that it is curable and your hearing can recover as ear drum is sticked to back side of both the ears. I have already gone an open cut surgery of my right ear and I am frightened to go to operation of my left ear. Please advice.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (4 hours later)

Hi

Thanks for the query

The failure of the tympanoplasty is due to the poor ventilation of the middle ear, this could be either due to adenoid hypertrophy or the inner ear. The middle ear is usually ventilated through the tube connecting nose and the ear called as Eustachian tube.

Adenoid hypertrophy can block the nasal end of the tube leading to reduced ventilation of the middle ear. As you have already undergone adenoidectomy, the Eustachian tube blockage should be relieved by now, if it were to be the main cause. In your situation, the block is not relieved completely even after the surgery, which means there could be Eustachian tube dysfunction which is the cause for failure of the surgery.

I feel the retraction or sticking of the ear drum to the middle ear will not improve with the surgery. It would be better if you can try doing steam inhalation and using steroid nasal spray for sometime, which may restore the ventilation of the middle ear.

Hope I have answered the query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (2 hours later)

Sir, Thanks for your reply.

I never felt any pain in my ears, but feel fullness always.
My nose never blown any single drop. Pathways are open in both nostrils.
Also I never feel any pain in my ears while going up in lift, climate change and even while travel in aeroplane.

When I try to pop my ears up, by taking long breath inside and close mouth and nose, I got success immediately by feeling
a pop up in my ears. But in left year it is quite early and in right ears in some delay as compared to left one.

I have hearing loss since when i was 8, and able to get understand the voice of persons by reading their lips. In noisy
condition (Work shop) at my office I have no problem as people speak loudly, but face a lot of problem in silence especially
in conference room. I couldnot listen the voice but could not understand, & some times even could not listen too.

I am not using any hearing aid till date, but once I tried in my right rear CIC type, that also come out after some time,
in such a way that some inside pressure pust it out from my ear.

Doctors told they will do surgery and see any obstruction in media (Malleus, incus or stapes) which transfer sounds from ear drum
to cochlea.

my querry after above explaination & your last reply, that
1. If during surgery, obstruction in malleus, incus or stapes, seen, can it be curable and do i got my hearing back?
2. If there is no any obstruction in malleus, incus or stapes seen during surgery but eustachian tube dysfunction observed do it also be corrected by surgery that time and do i got my hearing back?
3. If still you think surgery will not be successfull, can i go for hearing aid CIC type in both the ears?

Please advice.

Rajesh XXXXXXX

Answered by Dr. Dr. Naveen Kumar Nanjasetty (9 hours later)

Hi XXXXXXX

Thanks for writing back

1.     If during surgery, obstruction in malleus, incus or stapes, seen, can it be curable and do i got my hearing back?

There are various causes for the obstruction of the ossicular movement; it could be due to destruction of the ossicles, calcium deposition, cholesteatoma formation, etc. Only after approaching the middle ear the status of the ossicles can be commented.

Regaining of the hearing again depends on the status of the middle ear ossicles and the inner ear apparatus (sensorineural). Even though the ossicular chain is intact, but if there is problem with the cochlea or the auditory nerve then there will be no improvement in hearing. This is best decided before the surgery with a pure tone audiometry.

2.     If there is no any obstruction in malleus, incus or stapes seen during surgery but tympanometry. Tympanometry is a procedure to measure the pressure of the middle ear, the Eustachian tube function and the volume of the external auditory canal. It is difficult to correct the Eustachian tube dysfunction with surgery.

3.     If still you think surgery will not be successfull, can i go for hearing aid CIC type in both the ears?

It is difficult for me to comment whether there will be any improvement in the hearing or not; it can be determined only after seeing the audiometry result. If it is only a conductive hearing loss, then the chances of improvement in the hearing will be higher following surgery. But, if there is sensorineural hearing loss, then it would be wise to get a hearing aid, as the benefit you gain from the surgery is minimal. Yes, definitely you can go for completely in the canal (CIC) hearing aid, if you desire so.

I would suggest you to send me the audiometry report, if any, so that I would be able to help you in a better way.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (18 hours later)

Sir, Historical Audiometry test reports are attached, please see and advice for operation.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (15 hours later)

Hi XXXXXXX

Thanks for reverting back!

I have gone through the audiometry results and noticed that your hearing is progressively decreasing. Compared to what you had in 1987, 1997 and now in 2009, the sensorineural hearing loss (weakening of the function of the cochlea and the auditory nerve) is progressively increasing.
The air bone gap (the gap noticed between the upper and lower set of curves) in the normal speech frequency (500Hz, 1KHz and 2KHz) on the graph shows:
     (R)Ear     (L) Ear

1987     58dB          35dB
1997     23dB          20dB
2009     33dB          30dB

This denotes that the air bone(AB) gap was greater in the initial days and the hearing loss was of conductive type. The chances of improvement in hearing following surgery are more in this stage. Now, the AB gap has reduced, with the presence of sensorineural hearing loss along with conductive hearing loss (Mixed type). Thus, the chances of improvement in hearing following surgery at this stage are minimal or almost nil.
Since, there have already been two unsuccessful attempts in the right ear; I would still suggest that you opt for a hearing aid in the right ear. For the left ear, you can either opt for surgery in which a ventilating tube could be inserted (I would recommend no other procedure be done) or a hearing aid.
I hope I have answered your query.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Above answer was peer-reviewed by : Dr. Aparna Kohli