ENT Surgical Specializations

Surgery for Otosclerosis & Hearing Loss

Stapedectomy

The procedure is indicated for otosclerosis and a conductive hearing loss where the small bones of the ear (ossicles) do not efficiently move. The procedure is done under local and mild anesthesia due to the saftey of the patient’s hearing and balance. With the patient awake, a small incision is made in the ear canal and the eardrum is lifted to expose the middle ear space. The stapes bone is removed and a small titanium prosthesis is placed in between the incus and the cochlea with some fascia to separate the cochlea from the prosthesis. Dr. Slater takes a little piece of tissue from the top of the ear above the temporalis muscle (fascia) and uses this for his graft. He packs the middle ear space with surgical packing and lays the eardrum back down and places packing in the ear canal as well.

Surgery for Vertigo

Endolymphatic Sac Decompression and Shunt

This surgery is indicated for vertigo for Meniere’s disease. This is a surgical procedure done in the operating room under general anesthesia. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more effective visual exposure and access to the middle ear space and behind the vestibular apparatus and cochlea (hearing and balance organs of the ear.) The endolymphatic sac is a sac of tissue that gives fluid to the ear organs and this sac is housed in bone. The bone is decompressed (surgically drilled away) from the sac still allowing it to be supported and housed in the bone but now without a constricting bony capsule totally housing it. A small piece of plastic is sometimes placed that drains away the fluid (the amount of fluid that drains is very small, close to a drop of fluid, and drains into the bone behind the ear.) The plastic shunt does not prevent the patient from being able to have a CT or MRI later in life like steel can with MRIs. The oval and round windows are in the middle ear space and these areas of the cochlear are covered with loose tissue. The middle ear space is packed with absorbable gauze and the incision is closed with absorbable sutures and the top of the skin is usually glued back together.

Vestibular nerve section

This surgery is indicated for vertigo. This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. The incision is made behind the ear usually requiring a minimal amount of shaving of hair. The incision allows the neurosurgeon to access the skull and drill through the skull to expose the cerebellum. This exposure allows the neurosurgeon to move the cerebellum back and allow access to the 7th and 8th cranial nerve bundle. After the vestibular (balance) branch of the 8th cranial nerve is identified, the nerve is sectioned or cut. This totally disconnects the balance portion of the ear from the brain on that side. Careful attention is applied in this procedure to not cut the hearing branch of the 8th cranial nerve, thus preserving the hearing. The skull defect is packed with thick tissue (usually abdominal fat harvested above the waist) and bone dust. The skin is closed with absorbable sutures and the top layer of skin is closed with staples or sutures. Patients are kept in the ICU overnight to monitor for cerebral spinal fluid leak or bleeding and then transferred to a hospital floor for monitoring usually for 2-3 more days in recovery before being discharged home.

Labyrinthectomy

This surgery is indicated for vertigo. This is a surgical procedure done in the operating room under general anesthesia. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more effective visual exposure and surgical access to the middle ear space and vestibular apparatus and cochlea (hearing and balance organs of the ear.) The vestibular apparatus is opened and entered stopping the function of the balance and hearing organs for that side. Thick skin and bone dust is placed in the void to prevent any leak of cerebral spinal fluid. The middle ear is also packed generously with absorbable gauze and the incision is closed with absorbable sutures and the top of the skin is usually glued back together. The patient is kept overnight in the hospital after the procedure to monitor for CSF leak and dizziness and usually discharged home the next day.

Semicirucular canal plugging

This surgery is indicated for recurrent positional vertigo or a semicircular canal dehiscence (absence of bone over the semicircular canal.) This is a surgical procedure done in the operating room under general anesthesia. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more effective visual exposure and surgical access to the middle ear space and vestibular apparatus (balance organs of the ear.) Depending on the indications of surgery, the semicircular canal is opened and fascia (tissue harvested from the top of the temporalis muscle in the surgical approach) is placed inside the canal to prevent the functional movement of fluid within the canal. Thick skin and bone dust is placed in the opening and around the canal to close this. The middle ear is also packed generously with absorbable gauze and the incision is closed with absorbable sutures and the top of the skin is usually glued back together. The patient is kept overnight in the hospital after the procedure to monitor for CSF leak and dizziness and usually discharged home the next day.

Middle Ear Surgery

Tympanoplasty/Mastoidectomy

This is a surgical procedure done in the OR under general anesthesia indicated for various middle ear conditions like severe infections of the middle ear space or a cholesteatoma (skin accumulation or cyst causing a chronic drainage and hearing loss) or larger perforations (holes) in the ear drum. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more efficient visual exposure and access to the middle ear space. The hole created is usually no larger than the size of a quarter and the defect in the skull created is very minimal. Depending on the indication for surgery, this access allows Dr. Slater to access the middle ear space and surgically address the middle ear space. The tympanoplasty part of the procedure involves a graft of tissue from the temporalis muscle (fascia) that is taken in the surgical approach or cartilage that is taken either from behind the ear or outside of the ear canal. The graft is placed over the eardrum and the middle ear space is packed with surgical absorbable (your body absorbs this) gauze and the skin is sutured or sewed back together with absorbable sutures and the outside wound is usually glued back together.

Suboccipital or Retrosigmod approach

This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. The incision is made behind the ear usually requiring a minimal amount of shaving of hair. The incision allows the neurosurgeon to access the skull and drill through the skull to expose the cerebellum. This exposure allows the neurosurgeon and Dr. Slater to move the cerebellum back and allow access to the 7th and 8th cranial nerve bundle. This exposure also can help to preserve hearing for specific location and certain-sized lesions. The skull defect is packed with thick tissue (usually abdominal fat harvested above the waist) and bone dust. The skin is closed with absorbable sutures and the top layer of skin is closed with staples or sutures. Patients are kept in the ICU overnight to monitor for cerebral spinal fluid leak or bleeding and then transferred to a hospital floor for monitoring usually for 2-3 more days in recovery before being discharged home.

Encephalocele repair

This is a surgical procedure done in the OR under general anesthesia indicated for a tegmen tympani dehiscence or encephalocele (absence of bone between the brain and middle ear space allowing for exposure of cerebral spinal fluid and possibly the brain outside the skull.) An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more efficient visual exposure and access to the middle ear space. The hole created is usually no larger than the size of a quarter and the defect in the skull created is very minimal. The middle ear space absence of bone is visually identified and covered with cartilage, bone dust, and fascia (tissue harvested from the top of the temporalis muscle in the surgical approach). Careful attention is applied so that the structures below this (the hearing bones) are not disturbed in their movement for hearing. The middle ear space is packed with surgical absorbable (your body absorbs this) gauze and the skin is sutured or sewed back together with absorbable sutures and the outside wound is usually glued back together. The patient is kept overnight in the hospital after the procedure to monitor for CSF leak and bleeding and usually discharged home the next day.

Tranlabryrinthine approach

This surgery is indicated for base of skull lesions (tumors) deep in the cerebellar pontine angle. This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. An incision is made behind the ear close to the skin crease of the ear and scalp and usually away from the hairline so rarely does hair need to be shaved away at all. The mastoid bone is drilled out to give much more effective visual exposure and surgical access to the middle ear space and inner ear (vestibular apparatus and cochlea, the hearing and balance organs of the ear.) The vestibular apparatus is opened and entered stopping the function of the balance and hearing organs for that side. This surgical approach allows removal of large lesions deep in the skull at the skull base and allows the safest way to preserve the function of the face (cranial nerve 7.)

Middle Fossa approach

For cerebellar pontine lesions (tumors) or total facial nerve paralysis

This is a surgical procedure done in the operating room under general anesthesia with the surgical assistance of a neurosurgeon, as it is a craniotomy. The incision is made behind the ear usually requiring a minimal amount of shaving of hair. The incision is made above and behind the ear and the temporalis muscle is partially cut to allow access to the skull. This approach allows Dr. Slater and the neurosurgeon access to smaller tumors in the internal auditory canal (the bony canal housing the 7th and 8th cranial nerves) with the best chance of preservation of hearing with this approach. The approach is also utilized for facial nerve palsy or facial paralysis within a 6 weeks time period of total paralysis to surgery. The bone of the internal auditory canal is decompressed or drilled away to allow the facial nerve to not be compressed. The skull defect is packed with thick tissue (usually abdominal fat harvested above the waist) and bone dust. The skin is closed with absorbable sutures and the top layer of skin is closed with staples or sutures. Patients are kept in the ICU overnight to monitor for cerebral spinal fluid leak or bleeding and then transferred to a hospital floor for monitoring usually for 2-3 more days in recovery before being discharged home.

 Acoustic Neuromas

Acoustic Neuroma is a benign tumor that arises in the internal auditory canal (skull bone surrounding the auditory nerve) or just outside the internal auditory canal from the nerve sheath of a vestibular (balance) nerve. This tumor, as it slowly enlarges, can compress the vestibular (balance) nerves, causing vertigo. In the early part of the tumor’s growth, the patient complains of unsteadiness. If compression of the auditory (hearing) nerve occurs, there is evidence of a sensorineural hearing loss with very poor speech discrimination. Tinnitus (ringing in the ear) may also be present. The facial nerve may be affected, but usually late in the course of this disease. [Northern, 1996]Dr. Patrick Slater is one of an extremely small group of doctors in Central Texas who perform surgery to remove acoustic neuromas. The surgery is performed with a neurosurgeon, and can often take multiple hours to complete.