Management

Most cases of conductive hearing loss can be managed by medical or surgical means. Treatment of these conditions is discussed in respective sections. Briefly, it consists of:

1. Removal of canal obstructions, e.g. impacted wax, foreign body, osteoma or exostosis, keratotic mass, benign or malignant tumours, meatal atresia.


2. Removal of fluid. Myringotomy with or withoutgrommet insertion.

3. Removal of mass from middle ear. Tympanotomyand removal of small middle ear tumours orcholesteatoma behind intact drum.

4. Stapedectomy, as in otosclerotic fixation of stapesfootplate.

5. Tympanoplasty. Repairof perforation, ossicular chainor both.

6. Hearing aid. In cases, where surgery is not possible,refused or has failed.

Congenital causes of conductive hearing loss

• Meatal atresia
• Fixation of stapes footplate
• Fixation of malleus head
• Ossicular discontinuity
• Congenital cholesteatoma

Tympanoplasty

It is an operation to (i) eradicate disease in the middle ear and (ii) to reconstruct hearing mechanism. It may be combined with mastoidectomy if disease process so demands. Type of middle ear reconstruction depends on the damage present in the ear. The procedure may be limited only to repair of tympanic membrane (myringoplasty), or to reconstruction of ossicular chain (ossiculoplasty), or both (tympanoplasty). Recons-tructive surgery of the ear has been greatly facilitated by development of operating microscope, microsurgical instruments and biocompatible implant materials.


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