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Q. Which conditions require completely removing the outer and inner ear?

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jun 03, 2017 and last reviewed on: Nov 03, 2021

Hello doctor,

I just have a general theoretical question. This is not related to my medical history, I was just wondering in general. How much of the ear is it possible to completely remove? Both inner and outer ear. What kind of conditions requires this kind of an operation? What after effects can one experience, besides deafness, after a complete ear removal? Thank you very much.

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Hello,

Welcome to icliniq.com.

  • In a surgery called radical mastoidectomy, we remove both inner and middle ear and occlude the canal. We do it in cases of malignancies of the ear, where you cannot remove the disease as well as preserve hearing. In earlier days, radical mastoidectomy was done for cholesteatoma.
  • Such a surgery would entail loss of hearing and balance on that side. However, the balance will not be affected as it is compensated by other ear and other organs, which help in balance and stature.

Hope this answers your query. Do revert if you need any further information, I will be happy to help you. For more information consult back.

Hi doctor,

Thank you for your quick answer. Is it possible to preserve the hearing and balance if just the outer and middle ears are removed? Can the hearing be maintained if you leave the inner ear?

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Hi,

Welcome back to icliniq.com.

Before I answer your question, I will discuss briefly the roles of various parts of the ear, namely, the outer, middle, and inner ears.

  • The outer ear, which includes the pinna, ear canal, and tympanic membrane serves to collect the sound and deliver it on the tympanic membrane or the ear drum in common parlance. The eardrum is attached to the handle of malleus. Malleus, incus, and stapes form the small bones of middle ear called ossicles. The ossicles are attached to each other. Malleus to incus and incus to stapes. The footplate of stapes is attached to the oval window.
  • Inner to the oval window is the inner ear fluid. Inner ear fluid bathes the inner ear cells, which are the sensory organs for hearing and balance, separate organs or cells for each function. From the sensory organs arise nerve filaments, which form the vestibulocochlear nerve and goes to higher centers in the brain.
  • When the middle and outer ears are removed or occluded and the inner ear kept intact, the sound gets conducted through the bone to the oval window and then stimulates the inner ear. This is less efficient than air conduction (the normal way). An example is when the wax blocks your external ear and you appreciate decreased hearing.
  • A patient with a defective inner ear can still be given a hearing ear to reasonable extents using cochlear implants when the auditory nerve is fine. When the nerve also is defective, then we must do an auditory brainstem implant

I must commend your thoughts and the questions you are asking are very thought provoking. Keep it up. Do revert for more. For further queries consult back.

Hi doctor,

Thank you so much. I really appreciate your answer. After an operation as you described, do the patient hear his or her voice inside the head, like when you have water in the ear after a swim? Is it possible to perform a tonsillectomy and a canthotomy during the same operation? Is it possible that the patient then will experience respiratory problems or other unfortunate side effects?

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Hello,

Welcome back to icliniq.com.

  • After an ear operation, whether the patient will hear his or her own voices in the head depends on the operations like radical mastoidectomy, where we remove entire ear. There is no way patient will hear anything at all. However, in the more common tympanometry and mastoidectomy surgeries, we pack the ear for varied time durations postoperatively.
  • During the time, the ear pack is present as well the time taken for the gel foam placed inside the ear to dissolve completely the patient may appreciate fullness and sounds such as that you mentioned. It is not unusual for the patient to feel no improvement in hearing even. The recovery is gradual but good depending on the skills of the surgeon, severity of the disease, recovery of the patient, comorbid conditions, and the postoperative care administered to the patient.
  • It is possible to do a tonsillectomy and canthotomy in the same sitting. If indicated, then the two procedures can be done on the patient. We do tonsillectomy using radiofrequency, coblation, and laser in our set up based on patient choice and our counseling. We feel coblation method is the best since postoperative recovery time is very less and the intraoperative bleeding is minimum.
  • Canthotomy, we usually do in adults where the facial development is complete and in special cases in children. Subsequent to a canthotomy, we usually pack the nose. Such a packing can be done with absorbable or nonabsorbable materials. Nonabsorbable materials require to be removed postoperatively alter three days, and these come with airway option to help to breathe through the nose itself. Combining the two does mean more discomfort to the patient, but with good analgesia, it can be managed. Do revert for any more doubts. I will be happy to help you. For more information consult back soon.

Thank you, doctor,

Hello again. Is it possible to use some hearing aid if just the outer and middle ear is removed? or can we use a cochlear implant instead? Best regards.

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Hi,

Welcome back to icliniq.com.

You may use a bone-anchored hearing aid or cochlear implant.


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