Endoscopic Ear Surgery

Appointment New Patient Appointment or 214-645-8300

At UT Southwestern Medical Center, our ear surgery specialists (neurotologists) have years of training and experience in minimally invasive transcanal endoscopic ear surgery. Our surgeons use advanced techniques to treat conditions such as infections, hearing loss, and tumors. 

Leading Expertise in Endoscopic Ear Surgery

Transcanal endoscopic ear surgery (TEES) is minimally invasive surgery to operate on tiny, delicate structures within the middle ear. It differs from traditional ear surgery in that surgeons access the middle ear through the ear canal rather than through an incision behind the ear. This causes less pain and results in faster recovery.

Most middle-ear conditions that we treat with TEES are not life-threatening, but they can greatly affect a person’s quality of life. As these conditions progress, they can destroy nearby structures, such as the ear bones, facial nerve, and the inner ear. Surgery is often necessary to avoid complications such as hearing loss, facial paralysis, balance problems, or brain infections such as meningitis, which can be life-threatening.

The neurotologists in our Comprehensive Skull Base Program are specialists in medical and surgical care for disorders of the ear, cranial nerves, and the skull base. We treat patients of all ages for hearing loss, balance problems, tumors, infections, injuries, congenital (present since birth) defects, and facial nerve disorders.

Our highly skilled team is pioneering research on TEES to improve currently used techniques and to discover more ways to use the advantages of the procedure. Our surgeons train neurotologists and otolaryngologists locally and around the world in the latest minimally invasive and open surgical procedures, and they also speak and present their research at both national and international conferences. UT Southwestern is one of only a few centers in the country that offers TEES, and we’re the first to use the procedure for the removal of acoustic neuroma tumors.

Treatment Options

Our skilled neurotologists perform TEES whenever possible to avoid the need for an incision behind the ear and an opening through skull bone. Endoscopic ear surgery offers several benefits over traditional ear surgery, such as:

  • No visible incision: The surgeon inserts an endoscope (very thin tube tipped with a light) through the patient’s ear into the ear canal to access the middle ear. Using the endoscope to visualize the surgical area, the surgeon uses tiny instruments to perform the operation. Avoiding an incision can help reduce patients’ pain as they recover.
  • Better view of the treatment area: An endoscope provides a wide field of view, allowing surgeons to see into tiny recesses within the middle ear. In traditional ear surgery with a microscope, surgeons have only a straight-line field of view, which limits the ability to see all areas for proper treatment.

Our experienced surgeons perform several procedures using endoscopic ear surgery, such as:

  • Ossiculoplasty: Reconstruction of the ossicles by either reshaping the patient’s existing bones or implanting a titanium prosthesis, to help restore hearing
  • Stapedectomy: Removal and replacement of the stapes bone to treat hearing loss caused by otosclerosis
  • Tumor removal: Removal of benign or malignant (cancerous) tumors such as acoustic neuromas or paragangliomas
  • Tympanoplasty: Repair of a perforated eardrum
  • Cyst drainage: Drainage of cholesterol granulomas and other inner-ear cysts can, in many cases, be performed using TEES

What to Expect

In most cases, patients who undergo endoscopic ear surgery can usually go home the same day of their procedure. Patients who are having a tumor removed typically stay in the hospital for two to three days.

We see patients for follow-up care one to three weeks after surgery. Patients typically come in to have their hearing checked about two to three months after surgery.

Conditions We Treat

Our experienced specialists use TEES to treat children and adults with conditions such as:

  • Acoustic neuroma: Also called vestibular schwannoma, this noncancerous tumor grows on the vestibular nerve leading from the inner ear to the brain. TEES can be used in selective cases to remove acoustic neuromas.
  • Cerebrospinal fluid (CSF) leak: The fluid that surrounds and protects the brain and spinal cord can leak through a hole in the meninges, the membrane that surrounds the brain. CSF leaks that cause symptoms in the ears typically occur in the temporal bone at the sides and base of the skull. Such CSF leaks can be congenital defects present since birth or acquired leaks that result from trauma, surgery, infection, or spontaneously.
  • Cholesteatoma: A benign skin cyst, made up of skin and dead skin cells, can develop in the middle ear. Cholesteatomas can be congenital or result from an ear injury or repeated ear infections. TEES can often be used to treat early cholesteatomas with superior visualization, no incision behind the ear, and quicker recovery.
  • Cholesterol granuloma: A rare, benign cyst can occur in the petrous apex, a section of skull bone near the middle ear. These cysts contain fluid, cholesterol, and other lipids.
  • Congenital or acquired ossicular chain fixation or discontinuity: Tiny bones in the middle ear (the ossicles) include the malleus (hammer), incus (anvil), and stirrup (stapes). People can be born with one or more ossicles that are either fixed (fused together), malformed, or missing. Acquired conditions can result from trauma, surgery, infection, or tumors. Because these bones transmit vibrations from the eardrum to the inner ear, any problems with the ossicles can cause hearing loss.
  • Facial nerve disorders: These conditions can result from an infection, injury, or other conditions such as a tumor. Facial nerve tumors, such as a schwannoma or hemangioma, an abnormal cluster of blood vessels, can press on facial nerves and cause symptoms such as twitching or paralysis in the face. TEES can occasionally be used to treat facial nerve disorders.
  • Osteoma: A type of slow-growing, benign tumor can develop in the bones surrounding the ear canal. Osteomas can cause pain, hearing loss, or frequent ear infections.
  • Otosclerosis: In this inherited disease, the stapes bone becomes fixed and no longer vibrates to transmit sounds to the inner ear.
  • Paraganglioma: Also known as a glomus tumor, this rare tumor most often develops in the temporal bone or the middle ear and is usually benign, typically presenting with patients hearing their heartbeat in their ear. TEES is helpful for removing many glomus tympanicum tumors.
  • Ruptured eardrum: A hole or tear in the eardrum, also known as a tympanic membrane perforation, can result from a foreign object in the ear, head trauma, a middle ear infection, or rapid pressure changes, such as from air travel or scuba diving.
  • Temporal bone encephalocele: An encephalocele occurs when brain tissue protrudes through an opening in the skull, which can result from an injury, surgery, or ear infection. A temporal bone encephalocele forms in the skull bone at the sides and base of the skull.
  • Tympanosclerosis: Chronic ear infections can cause scar tissue, calcium deposits, or new bone tissue to form in the middle ear. When the condition affects only the eardrum, it is called myringosclerosis.

Support Services

Patients who have had surgery to remove an acoustic neuroma can work with our vestibular therapy team. These specialized physical therapists work with patients before surgery, during their hospital stay, and after surgery. Patients receive a personalized exercise program to help them improve their balance and reduce dizziness, with physical conditioning to increase fitness and mobility.