Hearing Loss and hearing restoration
Hearing Loss – Understanding, Diagnosing and Treating Ear-Related Hearing Problems
Hearing loss can come on suddenly or gradually, affect one ear or both, and impact people of any age. For some, it means missing key parts of conversations. For others, it becomes a barrier to work, relationships, or confidence in everyday life.
Mr Patel offers a structured and compassionate approach to investigating hearing loss — combining detailed diagnosis with the latest treatments, including awake ear surgery, endoscopic repair techniques, and reconstructive options.
Types of Hearing Loss
There are two main categories of hearing loss, each with different causes and treatments:
1. Conductive Hearing Loss
This occurs when sound is blocked from reaching the inner ear. It may be caused by:
- Earwax impaction
- Fluid in the middle ear (glue ear)
- Eardrum perforation
- Otosclerosis (fixation of the stapes bone)
- Cholesteatoma or scarring
- Disruption of the ossicles (the tiny bones that conduct sound)
Many causes of conductive hearing loss are reversible with surgery or medical treatment.
2. Sensorineural Hearing Loss
This results from damage to the inner ear (cochlea) or the hearing nerve. Causes may include:
- Age-related hearing loss (presbycusis)
- Noise exposure
- Viral infections
- Genetic predisposition
- Sudden sensorineural hearing loss
- Ototoxic medication or trauma
Sensorineural hearing loss is often permanent, but hearing aids and implants can offer excellent benefit.
Some patients experience a mixed hearing loss, with both conductive and sensorineural components.
Symptoms of hearing loss
- Asking others to repeat themselves
- Feeling people are mumbling
- Struggling in noisy environments
- Needing to turn up the TV
- Tinnitus or ear pressure
- Feeling withdrawn or avoiding conversations
In children, hearing loss may show as delayed speech, inattentiveness, or poor school performance.
Diagnosis
Mr Patel provides a thorough assessment, including:
- Microscopic ear examination
- Audiometry – measuring hearing thresholds across frequencies
- Tympanometry – to assess middle ear pressure and function
- CT or MRI scanning, if needed, to investigate structural or nerve-related causes
- Exploratory tympanotomy – in selected cases of conductive hearing loss where no clear cause is seen on scans, a surgical exploration of the middle ear may be performed. This allows direct assessment of the sound transmission system, with reconstruction performed at the same time if appropriate
This meticulous approach ensures an accurate diagnosis — essential for selecting the right treatment and giving each patient the best possible outcome.
Treatment options
Treatment depends on the type and cause of hearing loss, and may include:
- Earwax removal
- Grommets, tympanoplasty, or ossiculoplasty
- Stapes surgery for otosclerosis
- Bone conduction or conventional hearing aids
- Hearing rehabilitation strategies
- Middle ear implants or cochlear implant referral (in cases of severe sensorineural loss)
- Sudden hearing loss protocols (including urgent steroid treatment)
OUR Approach – precise, personalised treatment
Philosophy
Mr Patel believes that understanding the cause of hearing loss is the first step to restoring confidence and connection. His approach combines detailed diagnostic assessment with innovative surgical techniques designed around the patient’s anatomy, hearing profile, and goals.
What Makes Us Different
Mr Patel offers a highly personalised and anatomically precise approach to hearing restoration:
- Awake ear surgery under local anaesthetic with sedation, allowing real-time feedback and communication with the patient
- Exploratory tympanotomy, where appropriate, to assess the ossicular chain directly and restore hearing during the same procedure
- Endoscopic surgical techniques allowing:
- Minimal disruption to surrounding tissue
- clear visualisation of the middle ear enabling more refined reconstructions
- Extensive experience with a broad range of hearing prostheses, including:
- Partial and total ossicular replacement prostheses (PORPs and TORPs)
- Footplate shoes for stability
- Lateral prostheses such as malleus replacement devices and angular clips
- Head-crimping designs to enable secure and functional coupling with the malleus
- This versatility allows Mr Patel to select the most appropriate prosthesis for the anatomical problem at hand, rather than adapting the repair to suit a limited set of prostheses
- A willingness to incorporate modifications and adjunct techniques to optimise prosthesis positioning, stability, and long-term function
This detailed, tailored approach ensures each patient receives the most suitable intervention for their specific hearing profile — helping to maximise the chances of a durable and successful hearing outcome.
Ossiculoplasty
Surgical Outcomes
Hearing Outcomes
For patients undergoing ossiculoplasty (reconstruction of the middle ear bones) to treat conductive hearing loss, the most important factor influencing success is the extent of erosion within the ossicular chain. When the stapes bone remains intact, outcomes are significantly more favourable than in cases where it has been eroded or disrupted.
Based on Mr Patel’s case series to date:
- 80% of patients achieve an air-bone gap closure to within 10 dB
- 90% of patients achieve an air-bone gap closure to within 20 dB
- Patients experience an average 56% improvement in their air-bone gap (the difference between actual hearing and hearing potential)
- 0% have experienced complete hearing loss, although the published risk of this complication is approximately 1%
These results reflect Mr Patel’s use of tailored techniques, a wide range of prostheses, and intraoperative hearing testing — all designed to maximise the chance of a successful hearing outcome.
Minimally Invasive, Scar-Free Surgery
- 100% of ossiculoplasty procedures to date have been performed entirely through the ear canal, with no external cuts required
- This endoscopic, minimally invasive approach helps preserve tissue and avoid post-operative scarring.
Awake vs General Anaesthesia
- 100% of patients in Mr Patel’s series have undergone surgery under local anaesthesia with or without sedation
- The awake approach allows for:
- Intraoperative hearing testing, helping to fine-tune reconstruction and maximise the chance of success
- A faster recovery, with most patients returning home the same day
- A more personalised, comfortable surgical experience