Our Summary

This research paper discusses a rare medical case of a 66-year-old man who had a hernia in his eardrum (also known as the tympanic membrane), which was extending into his outer ear canal. This condition caused him to experience a feeling of fullness in his left ear, hearing loss in both ears, and a discharge from his ears.

To treat this, doctors performed a surgery through the ear canal using an endoscope (a small camera) to totally remove the soft mass. They also inserted ventilation tubes into both of his ears. Examination after the surgery confirmed the diagnosis of a hernia in the eardrum.

It was found that the pressure needed to open the patient’s Eustachian tube (a tube that connects the middle ear to the upper throat and back of the nasal cavity) was higher than normal, and the tube was not actively opening.

The hernia in the eardrum most likely developed due to the patient frequently and forcefully blowing air out of his lungs while keeping his nostrils and mouth closed (a technique known as the Valsalva maneuver) over a long period of time.

FAQs

  1. What is a tympanic hernia and how rare is it?
  2. How was the tympanic hernia diagnosed and treated in this case?
  3. What could cause a hernia of the tympanic membrane according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about ear tube surgery is to avoid activities that involve straining or excessive pressure on the ears, such as heavy lifting or vigorous exercise, to prevent complications or damage to the ear tubes. It is also important to keep the ears dry and follow any post-operative care instructions provided by the doctor to ensure proper healing and function of the ear tubes.

Suitable For

Patients who may be recommended for ear tube surgery typically include those with chronic ear infections, frequent middle ear infections, persistent fluid behind the eardrum, hearing loss, or Eustachian tube dysfunction. In rare cases, patients with tympanic membrane herniation may also require ear tube surgery for treatment.

Timeline

Before ear tube surgery:

  • Patient experiences symptoms such as aural fullness, hearing loss, and otorrhea
  • Preoperative findings suggest a tympanic membrane hernia located in the external auditory canal
  • Patient undergoes diagnostic tests and evaluation to confirm the diagnosis
  • Decision is made to proceed with ear tube surgery to remove the hernia and improve ventilation in the ears

After ear tube surgery:

  • Total resection of the soft mass is performed using a transcanal approach with endoscopy
  • Ventilation tubes are inserted into both ears to improve Eustachian tube function
  • Histopathological findings confirm the diagnosis of a tympanic membrane hernia
  • Patient may experience some discomfort and temporary changes in hearing post-surgery
  • Follow-up appointments are scheduled to monitor healing and ensure proper function of the ventilation tubes.

What to Ask Your Doctor

  1. What is the purpose of ear tube surgery and how will it benefit me?
  2. What are the risks and potential complications associated with ear tube surgery?
  3. What type of anesthesia will be used during the surgery?
  4. How long will the surgery take and what is the expected recovery time?
  5. Will I experience any pain or discomfort after the surgery? If so, how will it be managed?
  6. Will I need to follow any special instructions or restrictions after the surgery?
  7. How long will the ear tubes remain in place and will they need to be replaced in the future?
  8. What is the success rate of ear tube surgery in improving hearing and reducing ear infections?
  9. Are there any alternative treatments or options available for my condition?
  10. How often will I need to follow up with you after the surgery for monitoring and evaluation?

Reference

Authors: Ikeda R, Miyazaki H, Kawase T, Katori Y, Kobayashi T. Journal: Auris Nasus Larynx. 2017 Feb;44(1):119-121. doi: 10.1016/j.anl.2016.04.009. Epub 2016 Apr 29. PMID: 27138366