Stapedectomy

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A stapedectomy is a surgical procedure of the middle ear performed to improve hearing due to a problem with the stapes bone. A person who might need a stapedectomy usually has a hearing loss that does not change, is not associated with any ear infections or pain, but has slowly lost the ability to hear clearly from one or both ears.  Maybe another family member also has a similar hearing loss.  The hearing loss does not change from day to day.


Your doctor and audiologist can identify whether or not the hearing loss is caused by a problem in the outer, middle or inner ear.  If your problem is associated with the middle ear, one of the most likely causes is otosclerosis.

Otosclerosis is a disease limited to the bone surrounding the middle and inner ear structures. It causes inflammation followed by thickening of the bone. The inflammation does go away but not before it traps the stapes, one of the three small middle ear bones. Normally these bones amplify the sounds that strike the eardrum. The stapes acts like a plunger and set the fluids of the inner ear in motion with each sound wave, but in this condition the stapes is frozen in place and less sound reaches the nerve fibers of inner ear. This impaired hearing is called a conductive hearing loss because the sound is not conducted and amplified normally by the middle ear.


Typically a person experiences a gradual loss of hearing in one ear without any other symptoms. The hearing loss often reaches 40 decibels or so which is a moderate hearing loss but rarely gets worse. In a few unfortunate people the inflammatory disease causes an injury to the nerve structures in the inner ear and this results in an additional sensorineural hearing loss. It is unpredictable whether the process will strike only one ear or both. 

Otosclerosis affects the ears only and not other parts of the body.  It is not associated with pain or infection.  The condition is accelerated during pregnancy and by birth control pills. 

The cause of otosclerosis is not completely understood, but it is an inherited disease.  It may be that the gene is activated by the mumps virus.  The disease happens to women slightly more often than men. It first appears in many people in their early twenties.  Although otosclerosis tends to run in families, it is unpredictable and not all children develop the disease.
 

Diagnosis

  • A hearing test (audiogram) identifies a conductive hearing loss, usually in the lower frequencies
  • Examination will eliminate other causes for the conductive hearing loss, such as ear wax or a hole in the ear drum
  • Sometimes a CT scan of the ear is needed to rule out other causes

What can be done about the problem?

A.) There is little available medicine for treating otosclerosis. The one opportunity is to use a combination of fluoride and calcium carbonate (Florical). This can be prescribed when there is a documented progressive loss of hearing or when a person with otosclerosis experiences dizzy spells. It cannot be used by people with severe kidney disease, with a history of kidney stones or stomach pains, or during the first trimester of pregnancy. The most common side effect is stomach distress (about 30% of patients stop the medication), but it can also cause arthritis and other muscle pains, tiredness, and irritability. Florical does not improve hearing but may slow or stabilize the progress of the disease and prevent dizziness although this is not a common symptom of this disease. The medication is best taken with meals and started with gradual increase in dose.

B.) The conductive hearing loss can be treated by wearing a hearing aid. For more information, ask your doctor.

C.) Some patients with only a mild degree of hearing loss may prefer to leave the hearing loss untreated. Since this is usually a slowly worsening hearing loss, it is recommended to check your hearing every year.

  Robinson titanium implant

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An implant has replaced the stapes

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D.) Stapedectomy is the surgical treatment which usually produces the best quality hearing. This is an operation where the "frozen" stapes bone is removed and replaced with a tiny metal Robinson prosthesis (< 1/8 inch in length) and a small piece of a vein, fat or a piece of collagen. The vein is usually removed from the back of one hand. The surgery is performed either under some sedation or general anesthesia (completely asleep). General anesthesia is often the safest choice. The surgery is performed through the ear canal with a microscope. The eardrum is lifted up and later repositioned without need for any visible incisions. The surgery takes about 1-2 hours and most patients are able to recover at home.

 

What's the chance of the operation working?

A stapedectomy has a high success rate. More than 90% of people have significant improvement in their hearing.

Who may not want a stapedectomy?

Someone who has:

  • frequent changes in barometric pressure (pilots and divers)
  • chronic difficulties with balance or dizziness
  • Chronic balance disorder
  • a job or a hobby which demands excellent balance
  • Meniere’s disease
  • a perforated ear drum or repeated ear infections
  • a large loss of hearing due to nerve damage (sensorineural hearing loss)

What could go wrong with the surgery?

  • The most frequent complication is injury to a small nerve that crosses the eardrum and operative site. The nerve is called the chorda tympani and supplies the sensations of salt and sweetness primarily to the back of one half of one side of the tongue. When this nerve is bruised or cut it can result in a metallic taste in the mouth or a reduced sense of taste. This change in taste usually goes away within the first six months after surgery without any specific treatment.
     
  • The eardrum can also be injured during the operation. For example, a hole may be inadvertently created in the eardrum but can usually be easily fixed.
     
  • There will be a 1-2 inch scar on the back of the hand where the vein is taken to make a graft to cover the hole into the inner ear. This can sometimes be tender or even become infected but should also be an easily treatable problem. Let your surgeon know if you have a history of unusual scarring.
     
  • A period of dizziness for several days after the surgery.
     
  • In rare instances (about 1 in 100) patients have a more significant complication which is not as treatable. These possible complications include: (1.) prolonged or permanent dizziness, (2.) a permanent hearing loss caused by injury to the structures of the inner ear, (3.) a persistent conductive hearing loss due to a problem with the repair, (4.) a ringing or buzzing sound in the ear (also known as tinnitus), and (5.) a permanent injury to the facial nerve that supplies movement to the facial muscles of expression.  These are the reasons why only one ear is operated on at a time.
     

What should I expect after surgery?

  • Most people have some spinning sensation, nausea and pain after this surgery for a day or two. Be sure to bring someone to drive you home. You will also need someone to stay with you at home for the first 1-2 days until you can safely walk without pain, nausea or dizziness and care for yourself.
     
  • Most patients experience a small amount of dizziness or buzzing but this should not last beyond the first several hours after surgery. If dizziness occurs and is mild, use Dramamine which can be bought at a pharmacy without a prescription. If the dizziness is excessive, call our office.
     
  • The patient needs to plan bed rest for several days after surgery. It is preferable to have one's head elevated at all times to minimize the pressure of the inner ear fluids on the new graft. If possible, one's head should be turned with the unoperated ear against the pillow. The operated ear should be pointed towards the ceiling.
     
  • No heavy lifting until permission from your doctor.
     
  • Avoid straining.  During the first week after surgery, (1.) use some form of laxative (for example, prunes, Metamucil, Colace, or a glycerine suppository), (2.) open one's mouth when sneezing, and (3.) avoid blowing one's nose, and (4.) limit one's travel and exercise plans.
    Heavy bearing down (caused by constipation), sneezing without opening one's mouth, and flying (avoid for at least 6 weeks) and strenuous or contact sports (minimum: 3 weeks absence- discuss with your doctor) or scuba diving (lifetime avoidance) can all cause excessive pressure on the new graft which must separate the fluid of the inner ear from the air space of the middle ear.
     
  • Do not be alarmed if you cannot hear normally after the surgery. This hearing loss is usually due to ear packing in the ear canal and fluid collecting behind the eardrum. The packing stays in the operated ear for a week. Cotton with or without a Band-Aid can be applied by the patient to the outer part of the ear canal when the original becomes soiled. Sometimes there will be a small amount of blood that can drain out of the ear canal. Call your doctor if there is a smelly discharge from the operated ear.
     
  • Usually your doctor will have the patient place about five (5) drops of antibiotic solution (such as Floxin, Cortisporin, Ciprodex or Cipro HC)  in the operated ear.  Occasionally your doctor will prescribe an oral antibiotic.
     
  • A piece of tissue from behind your ear or the back of your hand is often used during the surgery.  You can expect to have some sutures and dressing at one of these sites.  The cut will heal within a few weeks and there will be a short thin scar.  Your doctor will tell about any needed care to these sites. 
  •  
  • There may be some soreness or temporary numbness on the back of the hand or soreness around the operated ear.  But, in general, there is little pain associated with the surgery. Usually Tylenol is all that is needed.  A stronger pain medication is often also prescribed.  If there is excessive pain, call our office.
     
  • Notify our office, if you have a fever > 100 degrees F, excessive pain, a smelly ear drainage or dizziness.
     
  • In most cases, the patient can be back to normal activities and work within a week or two, although if the patient's job involves heavy lifting, three weeks of home rest is recommend. Discuss your progress with your surgeon before taking an airplane flight.
     

Your first visit to our office after surgery will be to check and possibly clean the ear canal. It may be weeks before your hearing has improved.

 

for a Post Op Handout, click here 

for patient counseling, click here
 

"I had a stapedectomy. The surgery was short & the pain after the surgery was minimal. I was out of work for 1 week; in bed probably the first 2 days of that week. There is an adjustment with hearing loud noises for another week after the bed rest. The recovery period was 2 weeks for me. The first week at home & the second week getting used to the ability to hear more. I’ve only had surgery this one time. I’m back after seven years to have the procedure in my other ear. I’ve been quite happy with Dr. Godley and this office." -Susan Andersen


 
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