Sometimes the hearing problem is due to damage in the small ossicles of the middle ear, not the eardrum or the auditory nerves.... In this case, ossification surgery can be the right solution.... This operation restores the auditory chain so that the sound reaches the cochlea again and the sense of hearing remains intact.

In this article from the health magazine GCORP LLC, we discuss what is osculoplasty surgery, what are its uses and how is it performed... We also point out the care after assiculoplasty, its benefits and possible complications.

What is aciculoplasty?

Aciculoplasty is one of the types of middle ear surgery that is performed with the aim of repairing or replacing the auditory bones (acicles). These bones include the following three items:

1. hammer (malleus)
2. Anvil (Incus)
3. Staples

Their main function is to transmit sound vibrations from the eardrum to the inner ear....If they are damaged for any reason, your hearing will be reduced....The following example will make it easier for you to understand how these delicate and small bones work:
Imagine you have a mechanical wristwatch that has three small gears....If one of these gears interferes or moves in the whole system..Ear; If one of the auditory ossicles is damaged, the sound is not transmitted well...

What is the use of osculoplasty surgery?

The cause of ringing in the right ear, hearing loss or even tinnitus can be caused by defects in the auditory chain..

Treatment of conductive hearing loss caused by bone damage

Damage, destruction or adhesion of the middle ear bone disrupts conductive hearing..

Compensation of bone damage caused by chronic ear diseases

One of the important uses of scoloplasty is to repair the auditory chain due to damage caused by chronic diseases of the middle ear.... These diseases can cause destruction, atrophy or adhesion of the ossicles of the middle ear over time, which leads to a decrease in conductive hearing. The sound path that causes hearing loss... These obstacles can be defects of the eardrum or ossicles of the middle ear. Typically, assiculoplasty helps to restore the mechanical connection between the inner ear and the ear.

In some rare cases where even assiculoplasty or other reconstructive ear surgeries are not effective, the doctor also suggests more advanced options such as auditory brainstem implant surgery, especially for patients with acoustic neuroma or severe auditory nerve damage.

Reconstruction of auditory chain after invasive ear surgeries

In cases where mastoidectomy surgery is performed to treat chronic ear infections, a part of the internal structures of the middle or outer ear may have been destroyed.. In this situation, after ensuring that the infection is completely removed, the surgeon performs oscilloplasty surgery to repair and reconstruct the ear structure... Of course, special care is required after mastoidectomy to prevent the infection from returning or creating an open cavity.

Correction of congenital anomalies of auditory chain

Some people are born with congenital malformation or absence of one of the middle ear bones.... In these conditions, ossification plays a reparative role and enables normal hearing by replacing or adjusting the bones.

Additional ear surgery next to tympanoplasty

If the patient has bone damage in addition to eardrum rupture, the surgeon usually performs tympanoplasty and aciculoplasty at the same time.

In very rare cases, due to ear cancer, some patients need a complete removal of the middle ear structures, after which, in the second step, assiculoplasty can be used to restore partial hearing.

What are the surgical methods of osculoplasty?

How to perform scoloplasty is different according to the condition of the middle ear bones, the amount of damage and the anatomy of the patient.. During it, the patient is usually under general anesthesia, not local anesthesia.. The invasive level of this surgery is low to moderate and the doctor performs the surgery through a small incision behind the ear.

In this method, if one of the ear bones is still healthy or usable, the surgeon cuts it and places it in the right place.. For example, if the incus bone is slightly eroded but its overall structure is still usable, the surgeon will shape it and use it as a bridge between the malleus and stapes.

In this method, because the doctor uses the tissue of the patient's own body, there is less chance of recurrence or infection, and it is also highly biocompatible, meaning that the body easily accepts it and does not show a significant inflammatory reaction or rejection against it.

2- osculoplasty using artificial prosthesis (allograft or prosthesis)

In many patients, especially those who have had a chronic middle ear infection, the tiny bones of the ear are destroyed and eaten, and the doctor can no longer use the patient's own natural bones.. In this case, the doctor suggests artificial prostheses to correct the auditory chain.

Types of prostheses used in scoloplasty

Types of ear prostheses for aciculoplasty surgery can be classified according to the size and type of prostheses in the following ways:

Speed ​​of auditory chain replacement

The amount of replacement of the auditory chain means how many bones of the middle ear need to be replaced. For example, if only one of these bones is damaged, a partial prosthesis is sufficient. Therefore, the rate of replacement is complete.... Based on this, the types of prostheses used in osculoplasty surgery can be placed in the following 2 groups:

1- Total bone replacement prosthesis (TORP)

This type of prosthesis is used when all three bones of the middle ear, i.e. hammer, anvil, and the movable part of the stirrup, are damaged or destroyed and can no longer be used... In this case, the TORP prosthesis plays the role of a complete bridge, that is, one end is connected to the eardrum or near it, and the other end is placed on the stirrup base, which usually remains fixed..

2- Partial bone replacement prosthesis (PORP)

This type of prosthesis is used when only one of the bones, which is usually the incus, is damaged... In this case, the PORP prosthesis acts as a middle piece, that is, one end of it is connected to the malleus or the eardrum, and the other end is placed on the stirrup.

The purpose of this prosthesis is to reconnect the remaining bones so that the sound is properly transmitted from the eardrum to the stapes.

Types of ear prostheses for osculoplasty surgery

Functional prostheses in the correction of the auditory chain are made of different materials, each of which has a great role in adapting to the body, durability and quality of sound transmission... 2 main and widely used types are:

1- Titanium

Titanium ear prosthesis is one of the most widely used materials in ear surgery.. This metallic material is light, very resistant and completely biocompatible.. so that it can transmit sound waves with minimal energy loss from the eardrum to more internal structures.... This feature makes it an ideal option for making hearing prostheses in both TORP and POPO types..

2-Hydroxyapatite

Another type of osculoplasty prosthesis is hydroxyapatite (a type of ceramic material) that has a chemical structure very close to the body's natural bone tissue... this structural similarity makes the body accept this material well and minimizes the possibility of an inflammatory reaction or rejection of the prosthesis.

In terms of sound transmission, the performance of hydroxyapatite is suitable.. although it has a weaker performance compared to titanium.... for this reason, in many cases, this material is used in combination with titanium.. For example, the tip of the prosthesis is designed from hydroxyapatite so that its contact with the delicate structures of the ear is softer.

One of the strengths of this material is its long-term stability, high biocompatibility, and suitable surface for tissue adhesion.... But on the other hand, due to being ceramic, the probability of this material being brittle is higher than metals, especially against sudden impacts or severe mechanical changes.

What are the cares after assiculoplasty?

The success rate and outcome of osculoplasty surgery does not depend only on the skill of the surgeon.. Instead, it is very important that the patient follow the aftercare of ear surgery to fully recover, prevent infection and restore hearing.

Rest and head position

In the first days after surgery, sleep in a semi-sitting position or at an angle of 30 to 45 degrees... This will help reduce swelling and prevent fluid accumulation in the surgical area... Sleeping on the operated ear is prohibited... as it can lead to displacement of the prosthesis or bleeding.

Preventing water from entering the ear

You should keep the ear completely dry until you remove the bandage and see your doctor again, which is usually 2 to 3 weeks later.

Avoid sneezing, blowing and pressure inside the ear

Fighting, sneezing with your mouth closed, or holding a sneeze can cause the prosthesis to dislodge or bleed into the middle ear

Regular use of medicines

Take the use of antibiotics seriously after osculoplasty to prevent infection.. Pain, fever, foul-smelling discharge or feeling of extreme heaviness in the ear are warning signs..

Avoid heavy and noisy activities

For at least 3 to 4 weeks, you should avoid vigorous physical activities such as sports, lifting heavy objects, bending too much... Being in noisy environments or listening to loud music can interfere with the hearing recovery process.

Not inserting a foreign object into the ear

Avoid manipulating the ear, inserting ear swabs, cotton or any other foreign object into the ear canal.

Also note that after surgery, you may experience symptoms such as ear congestion or even itching. Of course, the cause of ear itching is often related to superficial inflammation or a reaction to the dressing.

Regular visits and hearing tests

The initial visit is usually done 7 to 10 days after the surgery.... After placing the prosthesis, the doctor evaluates its condition by examination or imaging.... Hearing test (audiometry) is also usually done after 6 to 8 weeks to determine the final result of the surgery.

GCORP LLC is a trusted bridge for you to access specialist doctors such as otolaryngologist. Whether you are looking for online or face-to-face consultation, you can use the online services of the GCORP LLC platform anywhere in Iran.

What are the benefits of osculoplasty in the treatment of hearing loss?

The most important advantages of this ear surgery method can be summarized in the following:

• Modification of auditory chain
• Repairing the damaged structure of the ear
• Possibility of performing simultaneously with other surgeries
• Increasing the quality of life
• No permanent dependence on assistive devices such as hearing aids
• Long lasting

What are the possible side effects and risks of osculoplasty surgery?

Surgery to correct the auditory chain is usually safe and has a high success rate. However, potential risks include:

• Displacement or loosening of the hearing prosthesis
• damage to the facial nerve (facial nerve)
• Middle or external ear infection
• Perforation of the eardrum again
• Dizziness or temporary loss of balance
• Whistling or tinnitus

Although the above list may sound alarming, the reality is that most patients recover without serious complications after acetoplasty surgery... Choosing an experienced surgeon, following post-operative care and careful medical follow-up will minimize the risks.

What is the difference between scoloplasty and other treatment methods?

In the treatment of middle ear disorders that cause conductive hearing loss, there are various treatment methods... What technique the doctor recommends depends on factors such as the type of damage, the severity of the hearing loss, the age of the patient, the condition of the eardrum, and the history of ear diseases.

Comparison of aceculoplasty and tympanoplasty

Tympanoplasty is used to repair the tympanic membrane or eardrum.... You need this surgery when the eardrum is torn or perforated.... This tear may be due to chronic infection with trauma or previous surgeries.... In fact, if we imagine the ear as a drum, tympanoplasty repairs its surface better.>

In other words, if only the eardrum is torn, tympanoplasty is sufficient.... If the ossicles are damaged or the auditory chain is separated, you need ossification.... Sometimes you will need both surgeries.

Comparison of osculoplasty and stapedectomy surgery

Stapedectomy is a special surgery to completely remove the stapes bone....sometimes due to a special disease called otosclerosis, this bone becomes stiff and immobile and prevents the transmission of sound to the inner ear....in this operation, the stapes bone is replaced with a prosthesis..

In fact, it can be said that osculoplasty is a more general surgery to reconstruct the auditory chain, while stapedectomy is a more specialized and limited surgery that is used only in a specific disease, namely otosclerosis.

Comparison of aceculoplasty with hearing aids

If the patient is not a suitable candidate for surgery for any reason, for example, he has underlying diseases, the previous surgery was not successful, or the ossicles and the middle ear are severely damaged, in this situation hearing aids will be the best alternative to strengthen hearing... Hearing aids, especially for people with conductive or sensorineural hearing loss, help to hear environmental sounds clearer and louder without the need for surgery.

Actually, oscilloplasty is a surgical treatment to correct the auditory structure.. If it is successful, the patient no longer needs a hearing aid.. On the other hand, a hearing aid is a hearing aid, not a treatment.

Comparison of osculoplasty with cochlear implantation

If the hearing damage is very extensive and assiculoplasty cannot restore hearing function, sometimes the doctor suggests cochlear implantation as an alternative to direct sound transmission to the auditory nerve.

Comparison of acetuloplasty with tympanomastoidectomy surgery

Tympanomastoidectomy surgery is a more extensive surgery than osculoplasty, which includes removing parts of the mastoid bone (the part behind the ear) and repairing the tympanic membrane. This surgery is usually performed in cases of chronic ear infections, ear cysts (cholesteatoma) and severe damage to the main mastoid tissue in the middle ear. There is the prevention of the spread of the disease and it may also include reconstruction, but its main focus is the cleansing and treatment of the disease.

Aciculoplasty in several lines

Aciculoplasty is a type of reconstructive surgery in the middle ear that is performed to repair or replace the damaged auditory bones. This method can restore a part of the lost hearing without the need for permanent use of hearing aids.. If you have conductive hearing loss and the cause is related to damage in the middle ear bones, consultation with an ear, nose and throat specialist can be the first step in the path of effective treatment.

If you need help and advice about ear conditions or surgeries such as bone surgery, you can chat and schedule an appointment online with an otolaryngologist or internist at GCORP LLC.

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Source: pennmedicine | Medanta optecoto