Ear

[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern” el_class=”servbox”][vc_column][vc_column_text]The basic function of the ears is to receive, amplify and convert sound into a neural impulse (an electric signal) that is sent to brain so that one actually hears).

The external ear is made up of the pinna (auricle) and the external auditory canal (ear canal).

The middle ear is made up of the tympanic membrane (ear drum) and the ossicles (the 3 bones of hearing). These are the malleus, incus and stapes.

Dr. Prahlad Duggal at DuggalENT offers specialty care for deafness, tumors, trauma, infection and dizziness. Success rates and complications of treatment vary considerably with each individual patient and we offer tailor made solutions for each patient.

There are different types and causes of hearing loss. Similarly, there are many types of treatment options that are used to restore hearing to people with hearing loss. Knowing the cause and degree of hearing impairment can help physicians determine which option is right for you.

Microsurgery of ear

Most of the surgeries on ear are performed under a state of the art microscope which gives a clear and magnified view of the middle ear structures. Optimal results in ear surgery can only be obtained by use of an operating microscope which makes both the hands of the operating surgeon free. An assistant port gives a magnified view to the assistant also which helps in better co-ordination during surgery with excellent results.

Endoscopic ear Surgery

Endoscopic ear surgery is an evolving technique that is a valuable adjunct to the traditional microscopic approach to ear surgery.

At DuggalENT we perform endoscopic ear surgery in selected cases as it allows a more minimal approach with the goal of maximising function, whilst still adequately addressing the disease. Endoscopic ear surgery gives improved visualisation and appreciation of the complex anatomy of the ear through a minimally invasive way thereby offering better disease clearance with minimal tissue manipulation.

We have all the specialised equipment required for endoscopic ear surgery in addition to our standard operating microscope and microscopic instruments.

Chronic discharging ears:

Chronically discharging ears most of the times have ruptured ear drum with or without bony involvement though certain other causes also lead to ear discharge.

Microsurgery of the ear:

Ruptured ear drums usually require surgical repair and is done under microscope. Microsurgery of ear is out forte as Dr. Prahlad Duggal has performed more than three thousand micro ear surgeries with an over 90% success rate.

Tympanoplasty

Tympanoplasty or reconstruction of the middle ear hearing mechanism serves the purpose of rebuilding the ear drum and/or middle ear bones. We always inspect the ear ossicles (small bones of hearing chain) during ear surgery and do need based repair of ossicular chain. Temporalis fascia is the most used grafting material in our tympanoplasties though perichondrium or sliced cartilage is also used. Nearly all tympanoplasties are performed in day care settings though long distance patients stay overnight.

Tympanomastoidectomy

When there is involvement of mastoid bone (bone behind the ear), the disease needs to be cleared from the mastoid and the procedure is known as Mastoidectomy, Depending upon the type of disease, cortical mastoidectomy, modified radical mastoidectomy, atticotomy or a combination of different procedures is done so as to ensure complete clearance of disease form the middle ear cleft. We are also doing single stage mastoidectomy with ossicular prosthesis in cases where ossicular loss is there. This helps in restoring the hearing mechanism in a single stage surgery and avoids the need for a second stage surgery.

OSSICULAR RECONSTRUCTION

Ossicles are the small bones present in the middle ear which for the sound transmission mechanism. Patients having complete or partial loss of ossicles are given the option of various types of ossicular prosthesis available for restoring the hearing mechanism. Materials commonly used by us are:

  • Autografts- Bone
  • Bone/Cartilage
  • Ossicles
  • Precious Metals – Gold Platinum Titanium
  • Ceramics
  • Plastics

We routinely do single stage mastoidectomy and ossiculoplasty using prostheses with excellent results in our patients. All our patients are given the option of ossiculoplasty during counseling for tympanoplasty.

Stapedotomy

Otosclerosis is a disease in which the stapes (third ossicle) gets fixed because of new bone formation in the region. Usual presentation is a conductive type of hearing loss with intact ear drum and treatment is by replacing the stapes with a piston.

Otosclerosis affects only the ears and involves both ears usually one after another. It occurs in both men and women but women are usually affected slightly more frequently. This is a disease of the early middle age and thus affects people in the prime of life. Pregnancy is known to aggravate the situation. Otosclerosis tends to be familial, but there is no pattern to its heredity.

Sudden hearing loss

Sudden hearing loss (SHL) is defined as hearing loss more than 30dB, over at least three contiguous frequencies, occurring over 72 hours or less. It occurs most frequently in the middle aged with males being affected more than females. Hearing loss can be temporary or permanent and can be associated with symptoms of tinnitus and vertigo. The precise cause of SHL is not known though different theories have been proposed.

SHL is a semi-emergency as best results are seen with treatment within 72 hours. We offer a combination therapy for SHL as no single form of therapy has shown confirmed results. Our helpline is just a phone call away for such patients so that we can start emergency treatment.

The Ageing Ear

At DuggalENT, we care for the elderly in a compassionate way ao as to provide tailor made solutions to the age related problems.

Wax Impaction

Wax impaction is one of the most frequent ear related presentations in ENT practice. With increasing age, changes in ears due to atrophy of the ceruminous glands, anatomical changes as well as the use of cotton buds and the wearing of hearing aids all contribute to an impairment of the self cleaning mechanism of the canal. This predisposes to the repeated ear infections and irritation and can also interfere with the hearing aid function.

Wax removal in the most gentle way helps in significantly solving the problem of the elderly and also helps in optimum utilization of the hearing aids.

Hearing Loss

There are mainly two types of hearing loss, conductive and sensori-neural though a mixed type of hearing loss is also there. As a general rule, a conductive type of hearing loss should always be referred to a specialist.
The causes of conductive type of hearing loss are usually due to a defect in the sound transmission chain in the middle ear. A careful examination and audiological evaluation clinches the diagnosis. Surgical treatment is usually possible for such type of loss.

Age-related hearing loss (presbycusis) is the most common form of hearing loss, and the predominant neurodegenerative disease of ageing. It is generally slowly progressive, symmetric and irreversible, and in some has a genetic predisposition. Hearing aids are the most commonly used treatment modality for such type of loss.

Lesser common causes of sensori-neural hearing loss can be some tumours like acoustic neuroma and an MRI scan is the most sensitive investigation needed for making a diagnosis. A large percentage of these tumours, especially in the elderly, do not require active intervention, but need to be monitored on a regular basis.

Other types of hearing disability being faced by the elderly is Noise induced hearing loss and Drug induced hearing loss and both present with the neural type of hearing loss. Years of occupational noise exposure results in hearing loss in the middle aged and elderly. With increasing age and use of various drugs especially pain killers and antiplatelets result in sensori-neural hearing loss. Many a times, noise induced and age related hearing loss often co-exist, and hearing aids are the usual form of treatment offered to such patients.

Management of Hearing Loss

Hearing aids

Properly fitted and tuned hearing aids make a significant improvement to an ability to communicate and to overall quality of life, and are the mainstay in the management of hearing loss in these patients. Newer digital aids continue to improve hearing results and are selected on the basis of the features available and need of individual patient. Digital aids also enable the patient to give feedback regarding sound quality so that the audiologist can make appropriate changes.

Cochlear Implantation

When hearing aids lose their effectiveness, consideration of cochlear implantation should be made. As with the improvement in digital hearing aids, advances in implantable hearing aid technology has significantly increased the number of those who will gain benefit from their use. Though in India primarily used for congenital or other forms of childhood deafness, their use in elderly is also increasing.

Single Sided Neural Deafness

The patients’ in which the hearing on one side is reasonable and there is very little residual hearing in the other ear, a standard hearing aid is of no benefit in such patients. The only option for hearing rehabilitation is that of a bone anchored hearing aid. This utilises the very low attenuation of sound through bone conduction. A slight delay in the sound signal to the good ear allows the brain to create the illusion of binuaral hearing. It is especially helpful when hearing in background noise and for directional sense.

Tinnitus

Tinnitus is the perception of sound in the absence of external acoustic stimulation. For the patient it may be a very annoying condition and disturbs day to day life. The causes can vary in a large spectrum but most of the cases are associated with hearing loss. All such cases are offered medical treatment while those cases not responding to medicines are offered different aids and masking solutions.

Dizziness

Uncompensated vestibular hypofunction results in postural instability, visual blurring, and subjective complaints of imbalance. The assessment and management of dizziness is a multi-disciplinary challenge, but treatment of the vestibular dysfunction centers around vestibular rehabilitation. True rotational vertigo is more specific for peripheral vestibular pathology, with BPPV and vestibular migraine being the most common diagnosis.
Apart from medication at DuggalENT, we offer various rehabilitation measures including various maneuvers for vertigo.

Cosmetic ear surgery

At DuggalENT, cosmetic reshaping of the external ear for deformed ears and reconstruction of external ear for absent pinna is done with an aim to give near normal external ears to the patient.

Otoplasty

At DuggalENT, various forms of otoplasty procedures are routinely done for different pinna deformities like bat ear, lop ear or conchal bowl defects. Dr. Duggal is the most experienced ENT surgeon in the region who is doing otoplasty surgery in days care settings.

Pinna reconstruction

Pinna reconstruction at our centre is done using autologous rib grafts as well as polymer implants. [/vc_column_text][/vc_column][/vc_row]

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