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Overview

Otosclerosis is the medical term given to an abnormal growth of the stapes bone near the middle ear and it may result in hearing loss.

Stapedectomy

Procedure

There are various ways of managing otosclerosis, but surgical intervention is the method of choice and the procedure is known as a stapedectomy. 

The procedure entails removing a portion of the sclerotic (hardened) footplate of the stapes bone and replacing it with an implant that is fastened to another bone called the incus.

The procedure restores continuity of the ossicular movements in the middle ear and this allows adequate transmission of sound waves from the eardrum to the inner ear.

The success rate of the procedure depends on the skill and experience of the surgeon performing the procedure. A stapedotomy procedure is a less invasive surgery where a small hole is drilled into the footplate of the stapes bone with a laser or micro-drill and a piston-like prosthesis is inserted.

The stapedotomy has been shown to be at least just as an effective management of otosclerosis as a stapedectomy, with fewer complications associated with the former. Therefore, under normal circumstances, the stapedotomy procedure is preferred. 

Recovery time

After the procedure, the patient may experience a headache or some pain and they may feel dizzy for a few days. The ear will feel stuffy or blocked and this usually improves as the eardrum heals and after the surgeon removes the gauze or cotton packing from the ear canal.

This packing will be removed one to two weeks after the procedure and thereafter some blood-stained fluid may drain from the ear for one to three days. This is normal and shouldn't be any cause for concern as long as the fluid that drains gets less and less until it stops.

The patient's hearing may improve after the packing is removed but it can take about two to four weeks before there's a noticeable difference. The hearing continues to improve during the two months after the surgery.

Some recommendations for post-surgical care include:

  • Avoid blowing the nose and try to stop a cough or sneeze. If one has to perform these actions then they must keep their mouths open and not pinch their noses.
  • Patients should rest if they feel tired and try sleeping with their heads elevated for the first week.
  • Avoid sudden head movements for the week after the procedure.
  • Avoid strenuous activities and lifting heavy objects for two to four weeks.
  • Do not fly in an airplane, scuba dive, swim, or play contact sports until the doctor says it's safe to do so.
  • Don't get water in the affected ear for four to six weeks after the surgery.

Risks and complications

There are some risks associated with a stapedectomy and although they are rare, it is important that they are mentioned:

  • 4 percent chance of decreased hearing after the procedure and a 1 percent chance of complete hearing loss.
  • Ringing in the ears, called tinnitus, gets worse.
  • Severe and long-lasting dizziness.
  • Perforation of the eardrum which may need to be surgically repaired.
  • Post-surgical infection.
  • Taste disturbances due to injury to the nerve that runs through the middle ear and supplies a third of the taste to the tongue. 
  • Facial nerve paralysis due to injury to the facial nerve which also runs through the ear. This paralysis is usually temporary in those affected patients and it is extremely rare that permanent facial paralysis would occur.

 

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