Middle Ear Disorders: Interview with Dr. Ronchetti
Middle ear disorders are often diagnosed late, as symptoms—such as progressive hearing loss or mild, initially negligible discomfort—tend to be underestimated or develop slowly. Early diagnosis, however, is essential for effective treatment, even with minimally invasive techniques that help preserve hearing function and improve quality of life.
To explore the main disorders affecting the middle ear, their clinical manifestations, and the treatment options available today, we interviewed Dr. Francesco Ronchetti, ENT surgeon at UPMC Salvator Mundi International Hospital.
Dr. Ronchetti, What Do We Mean by “Middle Ear”?
The middle ear is the part of the auditory system located between the external auditory canal and the inner ear. It consists of the tympanic membrane and the ossicular chain (malleus, incus, and stapes) and serves to transmit sound vibrations captured by the outer ear to the inner ear, where the sound is transformed into nerve impulses.
What Are the Main Disorders Affecting the Middle Ear?
Middle ear disorders can impair hearing and, in more severe cases, impact patient’s overall health. The most common conditions include:
- Cholesteatoma: a whitish cyst that forms in the middle ear due to the accumulation of epidermal cells. Over time, it can erode surrounding bone structures. Main symptoms include progressive hearing loss, recurrent otorrhea (discharge of serous, mucous, or purulent fluid), and, in advanced cases, dizziness, facial paralysis, meningitis, or brain abscesses.
- Otitis media: an infection that can affect one or both ears, involving the tympanic membrane and the ossicles. It presents with otalgia (ear pain), recurrent otorrhea, and hearing loss.
- Otosclerosis: a hereditary condition that mainly affects women between the ages of 20 and 40, with potential worsening during pregnancy or menopause. It primarily affects the stapes, which become fixed and impedes normal sound transmission. Symptoms include hearing loss, tinnitus (ringing in the ears), and, in advanced cases, vertigo.
- Tympanic membrane perforation: rupture of the eardrum caused by acoustic or pressure trauma (such as incorrect use of cotton swabs), head trauma, or recurrent otitis media. It may cause ear pain, bleeding (otorrhagia), a sensation of ear fullness, hearing loss, and tinnitus.
How Are Middle Ear Disorders Treated?
Treatment of middle ear disorders may involve various surgical approaches, chosen based on the nature and severity of the condition:
- Ossiculoplasty: reconstructive surgery of the ossicular chain, which may use autologous grafts (cartilage or bone from the patient) or synthetic prostheses made of titanium or hydroxyapatite. Titanium is commonly used for its light weight and biocompatibility.
- Stapedotomy: a specific procedure for treating otosclerosis, which involves replacing the fixed stapes with a micro-prosthesis to restore sound transmission.
- Tympanoplasty: reconstruction surgery for damaged tympanic membrane.
Today, many of these procedures are performed using minimally invasive endoscopic techniques, which allow direct access through the external auditory canal. This approach avoids visible incisions and shortens postoperative recovery time.
How Long Does Middle Ear Reconstruction Surgery Take?
The duration of middle ear reconstruction surgery depends on the type of procedure, the complexity of the clinical case, the patient's condition, and the type of anesthesia used. On average:
- Complex ossiculoplasty or cholesteatoma surgery: may take more than 3 hours.
- Simple tympanoplasty: usually takes between 1 and 2 hours.
- Stapedotomy: a quick procedure, lasting about 20 minutes.
Each patient, however, requires a personalized assessment to define the most appropriate surgical and therapeutic approach.