Ear Procedures II

Comprehensive vocabulary flashcards covering surgical ear procedures, tympanoplasty classifications, mastoidectomy and stapedectomy instrumentation, auditory implants, and acoustic neuroma concepts.

Ossicular Chain Reconstruction

A surgical procedure performed to improve conductive hearing by replacing middle ear bones (stapes, malleus, and incus) that may have been damaged by injury or infection.

Associated Procedures with Ossicular Chain Reconstruction

Tympanoplasty and mastoidectomy, which may be performed in conjunction with an ossicular chain reconstruction.

Myringotomy

A non-sterile surgical procedure that still requires the surgical team to use sterile technique, typically utilizing mask anesthesia in pediatric patients, open glove technique without a sterile gown, and only a Mayo stand.

Myringotomy Wound Classification

Class II: Clean-contaminated.

Pressure Equalizing (PE) Tubes

Medical devices considered implants that must be documented in the patient chart according to healthcare facility policy as well as federal regulations.

Alligator Forceps (Myringotomy)

The instrument used by the CST to grasp the PE tube in its jaws and pass it to the surgeon.

Type I Tympanoplasty

A procedure where damage is limited to the tympanic membrane with all middle ear contents intact; a soft tissue graft is used to repair or replace the damaged ear drum.

Type II Tympanoplasty

A procedure where the destructive process extends beyond the tympanic membrane to include the malleus; the entire malleus or diseased portion is removed, and a graft is placed directly against the remaining portion of the malleus or the incus.

Type III Tympanoplasty

A procedure where both the malleus and incus are affected in addition to the tympanic membrane; the replacement tympanum is placed directly against the intact stapes, permitting sound transmission to the oval window.

Type IV Tympanoplasty

A procedure where the only remaining middle ear structure is the intact mobile footplate of the stapes; the graft seals the middle ear, rests directly on the stapes footplate, protects the oval window, and leaves an air pocket to protect the round window.

Type V Tympanoplasty

A procedure where the remaining footplate of the stapes is fixed and all ossicles are completely removed.

Autograft Timing in Tympanoplasty

Harvested by the surgeon at the beginning of the surgical procedure.

Micro-wipe

An item used rather than gauze to clean instruments during a tympanoplasty to keep items free of lint.

Gelfoam Pledgets (Tympanoplasty)

Dry or saline-moistened pledgets packed into the tympanic cavity to temporarily stabilize middle ear contents and create a bed on which the new tympanic membrane rests.

Mastoidectomy Graft Material

Temporalis fascia harvested and used as a graft during the procedure.

Rosen Pick (Mastoidectomy)

The instrument used by the surgeon to assess the mastoid antrum and remove cholesteatoma.

Alligator Forceps (Mastoidectomy)

The instrument used to pack the mastoid cavity with saline-soaked Gelfoam squares.

Frazier or Microsuction Tip ($5\text{-}$ or $7\text{-}$)

Suction tips used during a stapedectomy to remove fluid from the ear.

Roller Knife, Sickle Knife, or Flap Knife

Surgical knives used during a stapedectomy to create the tympanomeatal flap.

House Knife, Duckbill Elevator, or Drum Elevator

Instruments used during a stapedectomy to remove the posterior bony ledge once the tympanomeatal flap is created.

House or Guilford-Wright Joint Knife

An instrument used during a stapedectomy to disarticulate the incudostapedial joint.

Laser, Drill, or Sharp Footplate Pick

Instruments used during a stapedectomy to create an opening in the footplate.

Hough Hoe, Picks, or Footplate Hook

Instruments that may be used during a stapedectomy to position the wire prosthesis over the incus.

Sensorineural Deafness

Also called nerve deafness; involves impairment of the cochlea and the acoustic nerve.

Vestibulocochlear Nerve (Cochlear Implant)

The nerve that receives electrical impulses generated by the microphone upon cochlear implantation.

Internal Component (Cochlear Implant)

The component of the cochlear implant that includes electrodes placed inside the cochlea.

Outer Component (Cochlear Implant)

The speech processor component of the cochlear implant that converts sound into electrical impulses.

Bone Anchoring Hearing Aid (Baha)

A technology combining a sound processor, an abutment, and a titanium fixture implanted behind the ear.

Direct Bone Conduction

The process of transferring sound to a functioning cochlea via bone rather than through the middle ear.

Translabyrinthine Craniotomy

A surgical approach for large acoustic neuromas lasting approximately $4$ to $6\text{ hours}$; accesses the tumor through the inner ear without preserving hearing, but offers the best view of the facial nerve and requires less brain retraction.

Middle Fossa Craniotomy

A surgical approach used for smaller acoustic neuromas that carries the greatest risk for postoperative facial nerve weakness.

Suboccipital (Retrosigmoid) Craniotomy

An acoustic neurectomy approach that involves removing a section of the occipital bone behind the ear to remove the tumor.

Acoustic Neuroma

Also known as a vestibular schwannoma; a tumor that arises from Schwann cells and grows along the eighth cranial nerve.

Schwann Cells

The cell types that wrap around and support nerve fibers, from which acoustic neuromas originate.

Acoustic Neuroma Hearing Loss Prevalence

Hearing loss on the side where the acoustic neuroma is located occurs in $90\%$ of patients.

Trigeminal Nerve Compression Effect

Numbness in the face resulting from pressure exerted by a vestibular schwannoma.

Facial Nerve Compression Effect

Facial twitching resulting from pressure exerted by a vestibular schwannoma.

Vagal and Hypoglossal Nerve Compression Effect

Difficulty swallowing resulting from pressure exerted by a vestibular schwannoma.

Dura Mater Compression Effect

Headaches on the side of the tumor location resulting from pressure exerted by a vestibular schwannoma.

Bilateral Acoustic Neuroma

Acoustic neuromas occurring on both sides in individuals who have the genetic disorder neurofibromatosis type $2$.

Unilateral Acoustic Neuroma

An acoustic neuroma that occurs on only one side of the cranium.