The treatment of deafness has always been a major medical concern. The treatment of deafness has been progressing and developing, among which, surgical procedures, especially artificial hearing implants, have been rapidly developed in the last decade or so with the advancement of technology, solving many hearing problems that could not be solved by hearing aids alone. The following is an introduction to the surgical treatment of deafness and artificial hearing implants. I. Traditional ear surgery The classic treatment for chronic otitis media – tympanoplasty Since the development of tympanoplasty in the 1950s, it has gradually developed into four types of such surgery according to physiological function. In recent years, tympanoplasty has developed rapidly, and the indications for its treatment include: removal of focal middle ear lesions, repair of the tympanic membrane, reconstruction of the auditory chain, and restoration of the physiological function of the middle ear. Therefore, the advantages of tympanoplasty therapy are: 1. Highly effective in treating almost all ear diseases and complications, minimizing residual lesions, and restoring the continuity of the auditory chain in all chronic suppurative otitis media. 2. After surgery, the perforated tympanic membrane is closed and the mobility and continuity of the reconstructed auditory chain is good, making the physiology and morphology of the middle ear close to normal, and hearing will gradually improve after surgery.3. By using otomicroscopic instruments under a microscope for surgical operation, there is little surgical injury and fewer complications. Classical treatment for otosclerosis – artificial stapes surgery There is a not uncommon class of diseases that manifest as conductive deafness with normal tympanic membrane and progressive hearing loss, called otosclerosis. The main cause of otosclerosis is that the stapes in the auditory chain becomes fixed and its movement is limited, which affects the sound transmission function of the auditory chain, resulting in hearing impairment and clinical symptoms. The main treatment for otosclerosis is stapes surgery, which aims to restore the movement of the stapes floor or vestibular window, restore the conduction of the auditory chain, and then restore hearing. Classical treatment for congenital external ear malformation – hearing reconstruction for external auditory canal atresia Congenital external auditory canal atresia is a congenital birth defect that is seen after birth as an abnormal development of the external ear in newborns, manifesting as a small or absent auricle with no external auditory canal and possibly accompanied by malformed middle ear development. Currently this category can be well restored by artificial hearing implants such as vibrating acoustic bridges and bone-anchored hearing aids (BAHA), but traditional hearing reconstruction for congenital external auditory canal atresia still has its use, especially for some children with basically normal development of the bony external auditory canal and middle ear and only membranous external auditory canal atresia. Depending on the development of the external auditory canal, tympanic chamber and auditory chain, simple external otolaryngoplasty or external otolaryngoplasty can be performed. Cochlear implantation is a technique to implant an artificial electronic hearing device into the cochlea of patients with severe or profound sensorineural deafness (replacing the function of the cochlea) to directly stimulate the auditory nerve fibers in the cochlea. This means that external sound is converted into electrical stimulation to produce electrical hearing, and the patient needs to learn and train to re-establish the appropriate connection between sound and electrical hearing, thus enabling the patient to re-understand speech and return to the audible world. The procedure can be performed in pediatric patients as young as 12 months of age (FDA approved), and in some special cases, the age of implantation can be several months earlier. Patients with prespeech deafness have better results before the age of 8 years, especially before the age of 4 years. If the patient can wear a hearing aid for 3-6 months before the surgery and undergo aural rehabilitation, it will greatly help to improve the speech ability after the surgery. For adults with post-speech deafness, there is no significant age limit, and cochlear implants have been reported worldwide in people as young as 84 years old. In developed Western countries, the number of cochlear implants for deafness in the elderly is as high as the number of implants in children, greatly improving the quality of life of the elderly. Vibroacoustic Bridge, a middle ear implantable hearing device, has been used more and more widely in Europe and the United States for more than 10 years, and in May 2010, the Vibroacoustic Bridge, a new deafness treatment option, was introduced to China. In May 2010, this new deafness treatment solution began to enter mainland China, which will increasingly build a bridge for deafness patients to transmit their voices and allow unimpeded communication. There are many different causes of deafness, and diseases of the outer ear, middle ear or inner ear can all lead to deafness. Clinically, deafness is often divided into three main categories, namely sensorineural deafness, conductive deafness and mixed deafness. For patients with sensorineural deafness, hearing aids are often used for the less severe cases (where there is residual hearing available) and cochlear implants for the more severe cases (where hearing aids are ineffective or inefficient), while for patients with conductive or mixed deafness, the traditional treatment options are middle ear surgery or direct hearing aids. When a deaf patient has a vibrating sound bridge implanted, sounds from the outside world and from themselves are captured by the processor’s microphone and then encoded into a sophisticated electromagnetic signal that is sent across the skin to the implant. Once the implant receives the signal, it instructs the floating mass sensor to vibrate. Finally, this mechanical vibration is transmitted precisely into the inner ear, and the patient hears a clear and natural sound, which is significantly better than traditional methods, and this is where the greatest advantage of the vibrating sound bridge lies. New Hearing Rehabilitation Technology – Bone Anchored Hearing Aid (BAHA) BAHA, or Bone Anchored Hearing Aid (BAHA), is a device for treating deafness through bone conduction, which requires surgical implantation. The BAHA is used to help patients with chronic middle ear infections, congenital external atresia, and unilateral deafness who cannot use conventional hearing aids. This system requires surgical implantation and conducts sound through the bone conduction rather than the middle ear to the inner ear. BAHA’s hearing aid principle uses its own cranial bone conduction principle to send sound directly through the bone to the hearing part of the ear, bypassing the outer or middle ear hearing impaired area and producing clear sound without the sound distortion, feedback and uncomfortable earmolds that conventional hearing aids tend to cause. The perfect combination of hearing aids and cochlear implants – combined acoustic and electrical stimulation Combined acoustic and electrical stimulation is still broadly defined as a type of cochlear implant and is indicated for patients who are severely deaf in speech frequencies with good low frequency hearing on one side and totally deaf on the other side with <50% monosyllabic speech recognition rate and no progressive hearing loss. The principle of combined acoustic and electrical stimulation is to use short electrodes to stimulate only the auditory nerve fibers in the bottom part of the cochlea, and no electrode stimulation in the top part of the cochlea, so that electrical stimulation is used in the high-frequency acoustic area and acoustic stimulation is still used in the low-frequency area. Auditory brainstem implantation Auditory brainstem implantation is mainly indicated for patients with bilateral auditory neuroma or multiple neurofibromatosis after resection, cochlear ossification or auditory nerve hypoplasia. The working principle is similar to that of the cochlear implant, except that the cochlear implant stimulates the auditory nerve fibers in the cochlea to obtain hearing, whereas the auditory brainstem implantation involves implanting electrodes into the lateral saphenous fossa of the fourth ventricle to directly stimulate the auditory neurons in the brainstem cochlear nucleus complex to produce hearing. However, intraoperative positioning of the brainstem cochlear nucleus is much more complex than cochlear implantation and is influenced by a variety of factors, such as brainstem deformation due to early tumor compression, scar adhesions from previous surgery or radiation therapy, and operator experience. Incorrect electrode placement or postoperative electrode displacement may cause non-auditory responses such as myoelectric activity of the facial and linguopharyngeal nerves, which are not commonly performed in China.