Treatment of otosclerosis - Stapedectomy

The best possible treatment of otosclerosis is Stapedectomy. Stapedectomy is a surgical treatment for otosclerosis in which the immobilized stapes is removed, and a tiny platinum or stainless steel prosthesis is inserted in the middle ear to replace it. It is a very good and effective procedure. The fact is that the artificial stainless steel prosthesis is less than 1/8 of an inch long. The more extensive damage may require removal of the entire stapes footplate, while a small focus of disease allows for removal of less tissue. In Stapedectomy, the ear drum is turned forward and the fixed stapes is removed. After this, tissue is placed over the opening to the inner ear and a prosthesis is inserted and attached to the anvil.

Stapedectomy effectiveness

This operation has been performed for years now and the fact is that it is extremely effective and usually restores normal hearing in patients with conductive hearing loss. Patients can usually return to work in about a week.! Procedure is usually performed on an outpatient basis. Either local or general anesthesia may be used, depending on the comfort of the surgeon and the patient.  A small tissue graft, usually taken from a vein in the patient’s hand, is taken and used to seal the oval window after the prosthesis is inserted.

Possible complications of Stapedectomy
 
Hearing loss
It is clear that each manipulation of the stapes produces a reaction in the inner ear which can sometimes lead to giddiness and possibly hearing loss. However, in 90% of cases the results of stapedectomy are very good. In a small percentage of cases there may be severe or total loss of hearing in the ear which was operated on.
It is important to know that this may occur immediately after the surgery or be delayed for several years.
No improvement
In about 10% of cases the hearing is only slightly improved or there is no improvement.
Damage of the facial nerve
Since the facial nerve which supplies the muscles of the face runs through the middle ear, it occasionally gets damaged, producing a lop-sided weakness of the face.
Impaired sense of taste
Nerve called the chorda tympani supplies the sense of taste and it can often get damaged. This results in a temporary metallic taste which does not usually cause any significant problems.
Other complications
Giddiness with loss of hearing and tinnitus may occur after the surgery due to either a leakage of fluid around the artificial stapes, infections of the middle ear or some other conditions.

After operation tips

The evening after the operation, a patient should lie quietly on the un-operated ear. The surgery usually takes two to three hours. If all goes well, you can go home when you are fully awake and deemed ready for discharge by your doctor. Be sure to bring someone to drive you home.
It is not recommended to:

• Blow your nose
• Lie flat on the bed
• Remove any packing from your ear

Other tips:

• Do not get water in the ear
• No strenuous exercise
• Do not remove any packing
• Notify your doctor of fever greater than 100 degrees F, excessive pain, excessive drainage, or drainage that has an odor.

Alternative to surgery

In some cases, surgery is not possible and a hearing aid may be used instead. People who should not have stapedectomy include those who experience frequent changes in barometric pressure (pilots and divers), elderly patients with a baseline imbalance, people whose vocations demand excellent balance, and anyone with known Meniere’s disease (stapedectomy often causes permanent profound hearing loss in patients with Meniere’s disease). If a person has a perforated tympanic membrane due to middle ear infection, the infection must be cleared and the membrane healed before stapedectomy. Patients with sensorineural hearing loss or mixed hearing loss may not improve after stapedectomy, and are not likely to benefit from surgery.