ENT Surgical Specializations

Surgery for Otosclerosis & Hearing Loss

Middle Ear Surgery

Tympanoplasty/Mastoidectomy

This is a surgical procedure done in the OR under general anesthesia indicated for various middle ear conditions like severe infections of the middle ear space or a cholesteatoma (skin accumulation or cyst causing a chronic drainage and hearing loss) or larger perforations (holes) in the eardrum. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more efficient visual exposure and access to the middle ear space. The hole created is usually no larger than the size of a quarter and the defect in the skull created is very minimal.

Depending on the indication for surgery, this access allows Dr. Slater to access the middle ear space and surgically address the middle ear space. The tympanoplasty part of the procedure involves a graft of tissue from the temporalis muscle (fascia) that is taken in the surgical approach or cartilage that is taken either from behind the ear or outside of the ear canal. The graft is placed over the eardrum and the middle ear space is packed with surgical absorbable (your body absorbs this) gauze and the skin is sutured or sewed back together with absorbable sutures and the outside wound is usually glued back together.

Suboccipital or Retrosigmod approach

This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. The incision is made behind the ear usually requiring a minimal amount of shaving of hair. The incision allows the neurosurgeon to access the skull and drill through the skull to expose the cerebellum. This exposure allows the neurosurgeon and Dr. Slater to move the cerebellum back and allow access to the 7th and 8th cranial nerve bundle. This exposure also can help to preserve hearing for specific location and certain-sized lesions. The skull defect is packed with thick tissue (usually abdominal fat harvested above the waist) and bone dust. The skin is closed with absorbable sutures and the top layer of skin is closed with staples or sutures. Patients are kept in the ICU overnight to monitor for cerebral spinal fluid leak or bleeding and then transferred to a hospital floor for monitoring usually for 2-3 more days in recovery before being discharged home.

Encephalocele repair

This is a surgical procedure done in the OR under general anesthesia indicated for a tegmen tympani dehiscence or encephalocele (absence of bone between the brain and middle ear space allowing for exposure of cerebral spinal fluid and possibly the brain outside the skull.) An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more efficient visual exposure and access to the middle ear space. The hole created is usually no larger than the size of a quarter and the defect in the skull created is very minimal. The middle ear space absence of bone is visually identified and covered with cartilage, bone dust, and fascia (tissue harvested from the top of the temporalis muscle in the surgical approach).

Careful attention is applied so that the structures below this (the hearing bones) are not disturbed in their movement for hearing. The middle ear space is packed with surgical absorbable (your body absorbs this) gauze and the skin is sutured or sewed back together with absorbable sutures and the outside wound is usually glued back together. The patient is kept overnight in the hospital after the procedure to monitor for CSF leak and bleeding and usually discharged home the next day.

Tranlabryrinthine approach

This surgery is indicated for base of skull lesions (tumors) deep in the cerebellar pontine angle. This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more effective visual exposure and surgical access to the middle ear space and inner ear (vestibular apparatus and cochlea, the hearing and balance organs of the ear.) The vestibular apparatus is opened and entered stopping the function of the balance and hearing organs for that side. This surgical approach allows removal of large lesions deep in the skull at the skull base and allows the safest way to preserve the function of the face (cranial nerve 7.)

Middle Fossa approach

For cerebellar pontine lesions (tumors) or total facial nerve paralysis. This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. The incision is made behind the ear usually requiring a minimal amount of shaving of hair. The incision is made above and behind the ear and the temporalis muscle is partially cut to allow access to the skull. This approach allows Dr. Slater and the neurosurgeon access to smaller tumors in the internal auditory canal (the bony canal housing the 7th and 8th cranial nerves) with the best chance of preservation of hearing with this approach.

The approach is also utilized for facial nerve palsy or facial paralysis within a 6 weeks time period of total paralysis to surgery. The bone of the internal auditory canal is decompressed or drilled away to allow the facial nerve to not be compressed. The skull defect is packed with thick tissue (usually abdominal fat harvested above the waist) and bone dust. The skin is closed with absorbable sutures and the top layer of skin is closed with staples or sutures. Patients are kept in the ICU overnight to monitor for cerebral spinal fluid leak or bleeding and then transferred to a hospital floor for monitoring usually for 2-3 more days in recovery before being discharged home.

Acoustic Neuromas

Acoustic Neuroma is a benign tumor that arises in the internal auditory canal (skull bone surrounding the auditory nerve) or just outside the internal auditory canal from the nerve sheath of a vestibular (balance) nerve. This tumor, as it slowly enlarges, can compress the vestibular (balance) nerves, causing vertigo. In the early part of the tumor’s growth, the patient complains of unsteadiness. If compression of the auditory (hearing) nerve occurs, there is evidence of a sensorineural hearing loss with very poor speech discrimination. Tinnitus (ringing in the ear) may also be present. The facial nerve may be affected, but usually late in the course of this disease. [Northern, 1996]Dr. Patrick Slater is one of an extremely small group of doctors in Central Texas who perform surgery to remove acoustic neuromas. The surgery is performed with a neurosurgeon, and can often take multiple hours to complete.