Ear Surgery Question

[powerkoala]

If you were to perform a trans-tympanic endoscopy (push a fibre camera through a cut in the ear drum), would that person's hearing be restored once the small cut had healed (once the surgeon had covered it to bind it, that is). Would it effect future hearing of the person?

Would the person be deaf, until the wound had been bound? And what would you use on the drum to "stick" it together?

[student-2]

Any lesion of the tympanic membrane only partially affects conduction. The tympanic/ossicle complex accounts for the majority of conductive hearing but the skull also has some conducting ability. As for after the procedure- the tympanic membrane will probably heal if the incision was small and done in the proper place for incisions but will probably be a little sclerotic reducing the conductive hearing through that ear, sclerosis of the tympanic membrane is very similar to what happens in the elderly and accounts for the hearing loss in the elderly.
To make a long story short- no they won't become deaf, just slightly harder of hearing (very slightly)

[powerkoala]

Can you explain how this is done in laymans terms. Would a 1.9mm endoscope (fibre, with video) be used with a small scalpel and a touch of anaesthetic? How would the surgeon get an instrument and the endoscope into the inner ear at the same time (say they wanted to put the small scalpel through the hole?). Do the fibre endoscopes have have a light?

[student-2]

To be honest- I never saw the use of of endoscopes with the middle ear, I think it would be too traumatic but if someone knows otherwise I would love to hear.
Puncturing of the tympanic membrane is usually done in a very small incision in the pars tensa, ussualy when you want to drain an AOM. The puncture is made by a special lancet.
If you could attach any info about fiberoptics and middle ears I would love to read it. I like this field of medicine alot.

[powerkoala]

When you say AOM? What is this? I've heard of inner ear endoscopys from a book on ear surgery. I may type it sometime, if you reply. Sorry about not answering sooner. Things. The book refered to a procedure for puncturing that was covered in a different part, but it covered it briefly?

If fluid comes out of the ear drum, is it replaced when the wound is healed. (The book said you patch it up with a cigarette paper, and something elese I can't remember is available). What about the fluid? Is there a lot?

[student-2]

AOM= Acute Otitis Media
In general the middle ear is supposed to be pneumatized constantly to the pharyngeal area via the eustachian tubes. Blockage of this pathway will cause a SOM (Serous Otitis Media). Classicaly described as a "dull tymapnic membrane with reduced motion". So from this we can understand that fluid is not a normal component of the middle ear. (Inner ear and endolymph is an entirely different story...)
AOM is more because of bacterial infection (Strep. pneumonia, Haemophilus influenza b, Moraxella catarhallis are the main culprits).
Puncturing the ear drum is a procedure done to evacuate pus from the middle ear, excess pus can "eat away" at the ossicles and other connective tissue components of the middle ear. Such a therapeutic puncture usually heals itself.
In cases of other tympanic membrane punctures you can close the perforation by a procedure called tympanoplasty, where the surgeon approaches the middle ear canal medially to the tympanic membrane and plants a piece of fascia, usually obtained from temporal muscle. It's a very nice procedure!
As for cigarette paper- I dunno- maybe that's something historic or something I just don't know about- either way I would like to read about it if you could add the books name.

[Rohit Soans]

I have never heard of endoscopy for the middle year. There really is not much to be gained by direct visualization of the middle ear, at least in my experience. I am however curious about what the book you have been reading has to say about this. The incision made to drain the middle ear is usually small, does not effect hearing and is usually never patched (it heals well on its own). Please post a reference for this book as it seems very interesting. Thanks. Rohit Soans.