Surgery for hearing loss

Nearly 48 million Americans have some type of hearing loss that affects the communication, relationships, health and even the careers of those who have it. If you have hearing loss, you might wonder if there are surgeries that can restore your lost hearing. The short answer? It depends. There are ear surgeries to restore hearing if you have certain types of hearing loss. But only a small percentage of people with hearing loss are actually good candidates for surgery.

Surgery for sensorineural hearing loss

If you’ve been diagnosed with sensorineural hearing loss, you’re in good company. Also sometimes called “nerve deafness,” this is the most common type of hearing loss affecting adults, and it can occur for a variety of reasons—old age (presbycusis), exposure to sudden or persistently loud noise, disease and infections, head or acoustic trauma, tumors or medications.

Sensorineural hearing loss means the hair cells of the inner ear or the nerve pathways that connect the inner ear to the brain are damaged. These hair cells, located in the cochlea, are responsible for translating the noise your outer ear collects into electrical impulses and then sending them along the auditory nerve for the brain to interpret as recognizable sound.

Sensorineural hearing loss is permanent. No surgery can repair damage to the sensory hair cells themselves, but there is a surgery that can bypass the damaged cells.

Cochlear implants

Adults and children who are not helped by hearing aids for severe to profound hearing loss may want to ask about cochlear implants. Unlike a traditional hearing aid that amplifies sound, a cochlear implant bypasses the damaged part of the auditory system to directly stimulate the auditory nerve.

The two main components of a cochlear implant include:

• The implant—a small electronic device that is surgically placed under the skin behind the ear. It is connected to electrodes that are inserted in the cochlea.
• The external component—a unit that looks similar to a behind-the-ear (BTE) hearing aid. It has a microphone, speech processor and battery compartment. The microphone captures the sound that the speech processor translates into electrical signals. These signals are transmitted through the skin to the internal electronic stimulator, which sends the signal to the electrodes in the cochlea.

Cochlear implant surgery is usually performed on an outpatient basis once a thorough evaluation of a person’s health has been completed. This includes an examination of the ear and its anatomy, the auditory system and an overall physical examination. Most surgeons will not perform a cochlear implant surgery unless the patient has tried hearing aids without success. Because this surgery is invasive, it is reserved for severely hearing-impaired patients. 

Implantable hearing aids

Hearing aids have come a long way in the last ten years and one of the options currently available to those diagnosed with mild to moderately-severe sensorineural hearing loss may be the extended wear Lyric hearing aid, manufactured by Phonak.

The device can be worn up to several months at a time. Because it’s located so close to your eardrum, users say they experience more natural sound. The water-resistant device, inserted and programed by a certified Lyric provider, can be worn while showering and exercise.

A word of caution, though. The Lyric is not suitable for everyone. Those with small ear canals or with severe to profound hearing loss may not benefit from this technology. And while the Lyric is water resistant, it is not waterproof, meaning you can’t swim or dive with them in. Additionally, because the entire device is replaced six to eight times a year, the cost of this option is more expensive than traditional hearing aids.

Surgery for conductive hearing loss

Conductive hearing loss occurs when there is an obstruction or damage to the outer or middle ear that prevents sound from being conducted to the inner ear. Conductive hearing loss may be temporary or permanent, depending on the cause and sometimes, medical or surgical intervention can restore hearing.

Bone-anchored hearing systems

While many people have heard of cochlear implants, less well-known are bone-anchored hearing systems. They consist of an implant that’s surgically inserted into the bone behind the ear, and a hearing aid that fits tightly over the implant. When sound is detected, vibrations are sent via the bone to the inner ear. 

They are suitable for people with conductive hearing loss, such as children with outer or middle ear malformations. They also can be used on kids or adults with single-sided deafness. They require at least one functioning inner ear. 

PE tubes

If your child or grandchild has ever had an ear infection, then you know how agonizing this condition can be. According to the American Academy of Otolaryngology-Head and Neck Surgery, every child has at least one ear infection by the age of five. Although this condition usually clears on its own without causing permanent damage, some children have chronic episodes that can lead to long-term hearing loss, poor school performance and behavior or speech problems.

In cases like these, the pediatrician may recommend surgery to insert small tubes, known as pressure equalization (PE) tubes. Also referred to as tympanostomy tubes, myringotomy tubes or ventilation tubes, these tiny cylinders are placed through the eardrum by an ear, nose and throat (ENT) surgeon in order to allow air into the middle ear. Short-term tubes usually fall out on their own within six to eighteen months, while long-term tubes stay in place longer and may need to be removed by the ENT.

While toddlers and young children are the most common recipients of PE tubes, they might also benefit adults who suffer from the same condition. In addition to correcting chronic ear infections, the surgery may also be recommended to correct hearing problems associated with malformed ear drums or Eustachian tube, Down Syndrome or cleft palate.

Stapedectomy

People with otosclerosis may benefit from having a stapedectomy, a surgical procedure that implants a prosthetic device designed to bypass abnormal hardening of the bone tissue in the middle ear.  

Just as atherosclerosis causes hardening of the arteries, otosclerosis causes an abnormal hardening of the bone tissue in the middle ear. According to the National Institute of Deafness and Other Communication Disorders (NIDCD), this condition affects as many as three million Americans and typically happens when the stapes bone located in the middle ear becomes stuck in place. When this occurs, the bone is unable to vibrate and send sound through the ear, resulting in impaired hearing.

There are three types of otosclerosis:

• Stapedial otosclerosis, in which otosclerosis spreads to the stapes bone (also known as the stirrup) and prevents it from vibrating. This causes conductive hearing loss that can often be surgically corrected with a stapedectomy.  
• Cochlear otosclerosis, in which otosclerosis invades the cochlea and causes permanent damage to the sensory hair cells or nerve pathways that connect the inner ear to the brain. Because this type of otosclerosis causes sensorineural hearing loss, a stapedectomy is not an option.
• Mixed otosclerosis, which is a combination of both. This can occur as the disease progresses.

Symptoms of otosclerosis include progressive hearing loss, dizziness and tinnitus. 

Hearing loss surgery is not for everyone

Hopefully, in the not-so-distant future, people with hearing loss will have more options for restoring lost hearing. Currently, surgeries for hearing loss can only correct very specific losses while people with the most common types still benefit the most from simply wearing hearing aids. If you have hearing loss, see a hearing healthcare professional near you for regular hearing evaluations.