Abstract
Ear surgery in many ways lagged behind other surgical fields because of the delicate anatomical structures within the ear which leave surgeons with little room for error. Thus, while surgical instruments have long been available, their use in the ear would most often do more damage than good. This state of affairs remained the status quo well into the first half of the 20th century. However, the introduction of powered surgical instruments, specifically the electric drill used in conventional microscopic ear surgery (MES) and the ultrasonic aspirator, the Sonopet® Omni, in transcanal endoscopic ear surgery (TEES) marked major turning points. Yet, these breakthroughs have also raised concerns about whether the use of these powered surgical instruments within the confines of the ear generated so much noise and vibrations that patients could suffer sensorineural hearing loss as a result of the surgery itself. This paper reviews the intersection between the noise and vibrations generated during surgery; the history of surgical instruments, particularly powered surgical instruments, used in ear surgeries and the two main types of surgical procedures to determine whether these powered surgical instruments may pose a threat to postoperative hearing.
Highlights
The other type of hearing loss, sensorineural hearing loss, can be attributed to problems two main surgical procedures of microscopic ear surgery (MES) and transcanal endoscopic ear surgery (TEES) used in ear surgery to access the internal anatomy of within the inner ear, primarily the cochlea and associated hair cells or the vestibulocochlear nerve the ear; and a review of the literature on the potential for hearing loss caused by noise and vibrations
The vast majority of studies have focused on noised-induced hearing loss, which is a clear subcategory of sensorineural hearing loss, while vibrations, or more precisely, skull vibrations, have garnered much less attention until recently and deserve further study and consideration
This figure underscores that the Sonopet® Omni is reaching deep into the middle ear and closer to the ossicular chain and cochlea, which raises the specter of sensorineural hearing loss resulting from noise levels or vibrations, and is addressed below
Summary
The mastoid portion of the temporal bone lies behind the ear and serves as a solid, normally impenetrable, barrier protecting the internal ear This bony barrier has made it challenging to access the anatomical structures within the internal ear, which has primarily been accomplished by drilling straight through and removing the mastoid bone in a procedure called a mastoidectomy. This procedure has been the mainstay of ear surgery up until the turn of the 20th century. The majority of current ear surgery procedures can be broken down into two broad approaches: conventional ear surgery
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