[Surgical treatment possibilities of middle ear hearing loss]

Otological surgery is performed under the operating microscope with special microinstruments. The introduction of new technical means such as the argon laser, equipped with a fiberoptic handpiece, and the sceeter microdrill have improved the results according to the statistic of Berne. An important aspect is the approach to the structures in the temporal bone. The classical retroauricular and endaural incisions are replaced whenever possible by the less traumatic transmeatal approach directly through the external ear canal without external skin lesion. Ear drum perforations and cholesteatomas with and without ossicular lesions are repaired by different types of tympano-ossiculoplasty. Destroyed ossicles are replaced by allogenic prostheses or homologous ossicles. Otosclerosis is treated by a 'small-fenestra' stapedotomy with insertion of a teflon-platinum wire piston. Bone conduction hearing aids with conventional mastoid vibrators can be replaced by more efficient bone-anchored hearing aids directly fixed in the skull. The teamwork between ear surgeon, audiologist and electronical engineer has turned out to be important for the implantation of hearing aids.