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Restoration surgery after removal of advanced cholesteatoma. What can be done to get rid of my Eustachian tube blockage?

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Practicing since : 1991
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Four years ago I had restoration surgery on my left ear following the removal of an advanced cholesteatoma. Dr. XXXXXXX Kartush at the Michigan Ear Institute in the Detroit area performed the surgery that included a passive implant to replace my hearing bones. At about 8 months I was amazed by the level of hearing I had - it was really VERY good. But then, slowly, it faded and I now find myself almost as deaf as I was prior to the surgery. Dr. Kartush says the cholesteatoma has NOT returned and explained that the decrease in hearing is due to how the ear has finished it's healing process and the shape of the scar tissue as it has settled and made closure around the implant. I asked the obvious question-- well-- can't we just go back in and "shore up" things a bit? But his response is that doing so only creates more scar tissue and the process may well repeat itself-- i.e. works good for awhile but then fades again as the ear finishes healing. My Eustachian tubes in both ears are narrow. I was born with a cleft palate and lip and lost all of my hearing in the other ear (right ear) via mastoid disease as an 8 year old. The cholesteatoma in the left ear I'm told did some damage to the E tube at the end which aligns with the inner ear which complicates things. Blah blah blah -- HOWEVER, what is amazing to me is that sometimes when I simply yawn- yawn with intensity, for a few moments to a few minutes afterward my hearing is amazingly good!!! It's like a short term miracle or something. Hence my belief is that my E tube is simply dysfunctional and if it were operating properly the "closure" around the implant and "scar tissue formation as the ear healed" is NOT really a factor. If a simple yawn can make for a temporary miracle, what can be done to expound on this and get rid of my E tube blockage and/or dysfunction??? Dr. Kartush is now urging me to consider a BAHA but I'm reluctant to pursue this when I know that simply getting that E tube to work right makes such a difference. As for symptoms, I can hear my heart beating in my left ear, my own voice echoes in my head and sounds like I'm talking with my hand over my mouth. At times I feel pressure in the ear and a sensation of a water balloon rolling around in there. The lifelong ringing in my ears has increased to the point where it is nearly driving me crazy at times-- my head sounds like a combination of never ending white water rushing/waterfalls, a factory, every tone of a hearing test and and swamp with a million frogs and crickets. Thank you so much for your time and consideration! XXXXXXX Blackmore, Gaylord, MI
Posted Sat, 21 Apr 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 12 hours later

Thank you for your query.

1. The reluctance for revision ear surgery is due to many factors such as chances of causing total hearing loss or a dead ear while manipulating a previously placed ossicular replacement prosthesis, facial paralysis, labyrinthine damage while clearing scar tissue and so on.

2. Cleft palate and lip is often accompanied by cholesteatoma formation.

3. It is difficult to correct Eustachian tube dysfunction by surgery. This is because the function of the inner (nasal) end of the tube depends upon many factors such as palatal muscle function among others. In the case of the Eustachian Tube, anatomical patency does not translate to physiological function.

4. The improvement in hearing that you experience after the Eustachian tube opens up is in the conductive component of your hearing loss. Does your Audiometry show a mixed hearing loss?

5. It is not clear from your description whether you have a post-op mastoid cavity in the left ear. If not, a Tympanometry (Impedance Audiogram) will reveal any Eustachian Tube Dysfunction.

6. If your Tympanogram shows Eustachian Tube dysfunction, a myringotomy with a titanium grommet may help improve your hearing in the short term.

7. Scarring at the inner end of the Eustachian Tube is difficult to tackle as the XXXXXXX carotid artery is very close to this end. Re-stenosis may be prevented by stenting with silastic. Balloon dilatation is a new option.

8. I recommend that you undergo an MRI for cholesteatoma with HRCT (High resolution CT) Temporal Bones, which is a new scanning protocol before any further surgical intervention. It is an excellent tool to rule out any residual or recurrent cholesteatoma and observe every minute change in the structure of the middle and inner ear due to surgery and the present position of the prosthesis. You may share the images here.

9. If you have not taken a trial with a BAHA device, I will suggest that you do so. A BAHA is an effective system to tackle you hearing loss and tinnitus.

10. Your Tinnitus may be due to a bulky prosthesis. Recent success in reducing tinnitus has been with Caroverine injections and transtympanic steroid injections.

I must emphasize that you have been under the care of a leading and world renowned ENT Surgeon. I am assuming that all medical treatment trial has been exhausted.

I will require access to your examination and clinical findings, detailed reports including previous operative notes, hearing test results, radiology images to give any further suggestions.

I hope I have answered some of your queries. If you have any follow up queries, I will be available to answer them.

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