Ear Reconstruction Restores Nevada Woman’s Hearing and Balance

In 2021, while on a cross-country car trip with her husband, Diane Hartman couldn’t hear something he said, although she was right next to him. “I accused him of mumbling,” she says. “I had no idea that I was deaf in that ear because it had happened so gradually.”

When they returned home, a scan and a hearing test at her doctor’s office confirmed deafness in her left ear and revealed a cholesteatoma – a noncancerous growth behind the eardrum that blocked her hearing and caused pain and pressure. If left untreated, she was told, the growth could spread to her brain. “It was frightening,” says Diane, a registered nurse.

Within a month, she had surgery to clear out the blockage and reconstruct her ear. “They removed all my inner ear hearing bones, cleaned them off, and then put them back in. In the first three months, I got 100% of my hearing back. I had occasional pain, but all was well until after that time, when my ear became completely plugged and I had an off-and-on nagging pain. My doctor did another MRI and decided that it could be from drainage. I underwent a procedure to put in an ear tube to relieve the pressure, but when I awoke from that surgery, nothing had changed. I knew it wouldn’t work. I still felt the pressure, and the pain increased. It was like having ear pain while flying but not being able to pop my ear to stop it.”

At that time, November 2022, the couple had just moved from California to Reno, Nevada. “The pain in my ear now was a lot worse, a 6 out of 10,” Diane says. “Whenever I swallowed, I had to hold my ear because the pressure was so unreal. I started having vertigo, dizziness and nausea, and an underlying feeling of sickness all the time.”

Before this, Diane and her husband, Jon, a former downhill ski racer, had loved hitting the slopes near their new home at the base of Mt. Rose, but it became too difficult for her. “I was dizzy when skiing,” she says. “Even when I walked, I held onto my husband’s arm because it felt like the ground was moving. My depth perception was poor, and I would fall easily when going downstairs.”

Her primary care doctor sent her to an otolaryngologist (ENT), who conducted a test that revealed a profound hearing loss. “The pain and pressure were absolutely miserable,” she says. However, when the doctor couldn’t suggest a solution or further treatment options, Diane became distraught. “I left that office crying and unsure what I would do. I knew it was something I shouldn’t ignore.”

Jon, who had once lived in Cleveland, contacted friends there. They helped him set up an appointment with Edward Doyle, MD, a neurotologist with Cleveland Clinic’s Head and Neck Department. “When we met him, Dr. Doyle shook our hands and said he was grateful we were there,” Diane says. “He also said, ‘I want to hear what’s going on with you, and I want to help you.’ I immediately relaxed. When he ordered an MRI, I had it done the same day instead of having to wait six months. He also opened an additional day on his schedule for my surgery. I was blown away. Everything was so different from what I had been through before that. I felt the result would be different, too.”

Diane and her husband, Jon, enjoying skiing in the snowy mountains together. (Courtesy: Diane Hartman).

Dr. Doyle determined that retraction of Diane’s ear drum and an inability to equalize pressure in her middle ear had led to the cholesteatoma. Although this is a fairly common condition, he says, it is less common for the problem to become as severe as hers.

“She was in excruciating pain when she came to us, and I was concerned that we might not be able to make an impact,” he says. “But once in surgery, I could see just how retracted her ear drum was and repair it.” The surgery entailed rebuilding and strengthening Diane’s ear drum, as well as reconstructing her ear canal and dilating her eustachian tube to open it up.

“We have a team of people here who see chronic ear disease quite frequently and have experience in a variety of methods,” Dr. Doyle says. “It wasn’t a novel procedure, but we had to reconstruct more structures than we typically do. We placed a titanium prosthesis where a prior bone graft had failed and used that to reconstruct the bones of her ear. Her eardrum wasn’t connected to her cochlea, and we used the prosthesis to bridge the gap and restore the ability of her ear to take in sound from outside and convert it into a neural signal. Ultimately, we used five or six techniques during surgery, all done under a microscope. This included removing cartilage from another part of her ear, shaving it into numerous pieces, and then using a mosaic technique to rebuild the eardrum.”

Following the four-hour, same-day surgery, Diane used ear drops and let everything heal. “Her prognosis is good,” Dr. Doyle says. “However, this is a lifelong disease process, and we will have to monitor her yearly to be sure there is no recurrence.”

He advises that anyone experiencing hearing loss, intense pressure or infected ear drainage should see an ENT and have a hearing test, especially if the problem persists for three months or longer.

Diane now hears well and is pain-free. She also walks without assistance and is back up on her skis. “I recovered a lot faster than I thought I would,” she says. “Within a couple of weeks, I was feeling good. The dizziness went away, and I don’t have a problem with depth perception anymore. Just this season, I returned to skiing. We even taught my 6-year-old grandson how to ski this year. I was so impressed by the care at Cleveland Clinic, and by Dr. Doyle’s listening. He saved my life. It was far more than just an ear thing. I knew that I was at a world-class organization, and from check-in to surgery, I felt so taken care of.”