Hearing loss can be improved with surgery in some cases, such as when caused by the following.

Middle ear fluid:

Middle ear fluid is also known as Otitis Media with Effusion or Serous Otitis Media. When the Eustachian tube is too small or does not function properly, as a result of recurrent ear infections, the middle ear will become filled with fluid. This fluid is created by our own body but does not drain down the Eustachian tube. If the fluid does not drain, it will become thicker, ultimately becoming the consistency of dry rubber cement. This can lead to a permanent hearing loss, and in children can lead to a delay of speech development.

The operation to clear the fluid (Myringotomy with Tubes) is done through the ear canal. Using a microscope, the ear drum is magnified and a tiny incision is made in the ear drum. Fluid is suctioned out from the incision and a tiny plastic tube is inserted into the hole. This tube helps to prevent the recurrence of fluid. Typically the tube will stay for about a year. As the child grows, the Eustachian tubes usually enlarge, so when the tube comes out, most children will have outgrown the problem. On rare occasions, children will not outgrow the problem and will need to have tubes re-inserted. Some adults also need to have Myringotomy with Tubes when their Eustachian tubes do not function properly.

Tympanic membrane perforations:

The most common cause of a perforated eardrum is infection. When the middle ear is infected, fluid can build up, stretching the eardrum until it bursts. This will frequently relieve the pain and will usually be accompanied by drainage from the ear canal.

Other caused of ear drum perforations include:

• Head Trauma
• Slaps or a blow to the ear (for example, a hand slap to the side of the head)
• Changes in air pressure during flying or diving
• Sharp objects or even cotton-tipped swabs
• Car accidents
• Falls
• Sports injuries
• A sudden loud noise near the ear

In many cases, eardrum perforations heal themselves in a few weeks, however, some may take a few months. During this time, care should be taken to prevent water from entering the ear as well as avoiding additional trauma. Hearing is affected when an eardrum is perforated. The amount of hearing loss depends on the position of the hole and how large the perforation is.

A hole in the ear drum (tympanic membrane), results in a conductive hearing loss.

If the perforation is small, your physician may monitor it over time to ensure it is closing on its own. If it is larger, it may be patched using special chemicals that stimulate growth at the edges of the perforation and placing a tiny paper patch over the hole itself. By closing the hole, hearing should be improved, and the eardrum and inner ear may be better protected from water exposure. A paper patch may need to be applied more than once.

The operation to repair a tympanic membrane perforation (Tympanoplasty) is done either through the ear canal or from an incision just behind the ear. A graft is taken from the incision behind the ear and the graft material is used to patch the ear drum. Typically, the ear drum is lifted up in order to inspect the middle ear bones and the graft is place just behind the normal ear drum. As the ear heals the graft ultimately becomes part of the new ear drum.

Cholesteatoma:

A Cholesteatoma is a collection of infected skin material that grows in the middle ear space behind the eardrum. Once this material is behind the ear drum, it may continue to grow and expand, and can ultimately lead to permanent hearing loss by eroding the middle ear bones. A Cholesteatoma can even erode the bone separating the ear from the brain, and can lead to dizziness and facial paralysis by affecting nearby structures. There are three causes of Cholesteatoma:

• Repeated middle ear infections and poor Eustachian tube drainage: Usually when middle ear infections become chronic, the eardrum will be sucked inward due to a vacuum that is formed in the middle ear, as the fluid becomes thicker. This suction, which stretches the eardrum inward, can create a pouch or sac of skin. Eventually a skin-lined sac forms which continues to grow and causes infection and bony destruction.
• A perforation of the eardrum that occurs because of a chronic infection or direct trauma: The skin over the outer surface of the eardrum can grow through the perforation and into the middle ear, thereby leading to a Cholesteatoma.
• Cholesteatoma present at birth: This is due to skin being trapped during growth of the fetus. Congenital Cholesteatomas however, are not very common.

The operation to remove a cholesteatoma (Tympanomastoidectomy) is done through an incision just behind the ear. The mastoid bone is removed with drills and burrs under a high powered microscope and the Cholesteotoma is removed from the middle ear space and mastoid.

If the cholesteatoma is small and can be removed entirely in one piece, the eardrum and the middle ear bones (ossicles) are reconstructed all in one operation. If it is larger and cannot be removed in one piece then a second and sometimes third procedure may be necessary. This is important because any pieces left in the ear may begin to re-grow.

If the Cholesteatoma is extensive and is growing into the inner ear or facial nerve, it may not be possible to remove the entire Cholesteatoma, and a radical mastoidectomy has to be performed. If the damage is severe, reconstruction may not be possible.

Ossicular discontinuity or dislocation:

If one of the middle ear bones becomes dislocated from trauma or eroded from a severe infection, it would result in a conductive hearing loss. The operation to repair the bone (Ossicular reconstruction) is done by lifting up the ear drum and replacing the bone with an artificial one. The operation is usually performed through an incision behind the ear.

Otosclerosis:

This hearing loss is caused by a calcium build up around the stapes bone in the middle ear. The calcium prevents the stapes bone from vibrating and will lead to a conductive hearing loss. The disorder is often inherited. Treatment requires the replacement of the stapes bone (Stapedectomy) with one that is made of stainless steel or titanium.