stapedectomy

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Stapedectomy

 

Definition

Stapedectomy is a surgical procedure in which the innermost bone (stapes) of the three bones (the stapes, the incus, and the malleus) of the middle ear is removed, and replaced with a small plastic tube of stainless-steel wire (a prosthesis) to improve the movement of sound to the inner ear.

Purpose

A stapedectomy is used to treat progressive hearing loss caused by otosclerosis, a condition in which spongy bone hardens around the base of the stapes. This condition fixes the stapes to the opening of the inner ear, so that the stapes no longer vibrates properly; therefore, the transmission of sound to the inner ear is disrupted. Untreated otosclerosis eventually results in total deafness, usually in both ears.

Description

With the patient under local or general anesthesia, the surgeon opens the ear canal and folds the eardrum forward. Using an operating microscope, the surgeon is able to see the structures in detail, and evaluates the bones of hearing (ossicles) to confirm the diagnosis of otosclerosis.
Next, the surgeon separates the stapes from the incus; freed from the stapes, the incus and malleus bones can now move when pressed. A laser (or other tiny instrument) vaporizes the tendon and arch of the stapes bone, which is then removed from the middle ear.
The surgeon then opens the window that joins the middle ear to the inner ear and acts as the platform for the stapes bone. The surgeon directs the laser's beam at the window to make a tiny opening, and gently clips the prosthesis to the incus bone. A piece of tissue is taken from a small incision behind the ear lobe and used to help seal the hole in the window and around the prosthesis. The eardrum is then gently replaced and repaired, and held there by absorbable packing ointment or a gelatin sponge. The procedure usually takes about an hour and a half.
Good candidates for the surgery are those who have a fixed stapes from otosclerosis, and a conductive hearing loss at least 20 dB. Patients with a severe hearing loss might still benefit from a stapedectomy, if only to improve their hearing to the point where a hearing aid can be of help. The procedure can improve hearing in more than 90% of cases.

Preparation

Prior to admission to the hospital, the patient will be given a hearing test to measure the degree of deafness, and a full ear, nose, and throat exam.
Most surgeons prefer to use general anesthesia; in this case, an injection will be given to the patient before surgery.

Aftercare

The patient is usually discharged the morning after surgery. Antibiotics are given up to five days after surgery to prevent infection; packing and sutures are removed about a week after surgery.
It is important that the patient not put pressure on the ear for a few days after surgery. Blowing one's nose, lifting heavy objects, swimming underwater, descending rapidly in high-rise elevators, or taking an airplane flight should be avoided.
Right after surgery, the ear is usually quite sensitive, so the patient should avoid loud noises until the ear retrains itself to hear sounds properly.
It is extremely important that the patient avoid getting the ear wet until it has completely healed. Water in the ear could cause an infection; most seriously, water could enter the middle ear and cause an infection within the inner ear, which could then lead to a complete hearing loss. When taking a shower, and washing the hair, the patient should plug the ear with a cotton ball or lamb's wool ball, soaked in Vaseline. The surgeon should give specific instructions about when and how this can be done.
Usually, the patient may return to work and normal activities about a week after leaving the hospital, although if the patient's job involves heavy lifting, three weeks of home rest is recommend. Three days after surgery, the patient may fly in pressurized aircraft.

Risks

The most serious risk is an increased hearing loss, which occurs in about one percent of patients. Because of this risk, a stapedectomy is usually performed on only one ear at a time.
Less common complications include:
  • temporary change in taste (due to nerve damage) or lack of taste
  • perforated eardrum
  • vertigo that may persist and require surgery
  • damage to the chain of three small bones attached to the eardrum
  • temporary facial nerve paralysis
  • ringing in the ears
Severe dizziness or vertigo may be a signal that there has been an incomplete seal between the fluids of the middle and inner ear. If this is the case, the patient needs immediate bed rest, an exam by the ear surgeon, and (rarely) an operation to reopen the eardrum to check the prosthesis.

Normal results

Most patients are slightly dizzy for the first day or two after surgery, and may have a slight headache. Hearing improves once the swelling subsides, the slight bleeding behind the ear drum dries up, and the packing is absorbed or removed, usually within two weeks. Hearing continues to get better over the next three months.
About 90% of patients will have a completely successful surgery, with markedly improved hearing. In 8% of cases, hearing improves, but not quite as patients usually expect. About half the patients who had ringing in the ears (tinnitus) before surgery will have significant relief within six weeks after the procedure.

Resources

Organizations

American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince St., Alexandria VA 22314-3357. (703) 836-4444. http://www.entnet.org.
Better Hearing Institute. 515 King Street, Suite 420, Alexandria, VA 22314. (703) 684-3391.

Key terms

Cochlea — The hearing part of the inner ear. This snail-shaped structure contains fluid and thousands of microscopic hair cells tuned to various frequencies, in addition to the organ of Corti (the receptor for hearing).
Conductive hearing loss — A type of medically treatable hearing loss in which the inner ear is usually normal, but there are specific problems in the middle or outer ears that prevent sound from getting to the inner ear in a normal way.
Incus — The middle of the three bones of the middle ear. It is also known as the "anvil."
Malleus — One of the three bones of the middle ear. It is also known as the "hammer."
Ossicles — The three small bones of the middle ear: the malleus (hammer), the incus (anvil) and the stapes (stirrup). These bones help carry sound from the eardrum to the inner ear.
Vertigo — A feeling of dizziness together with a sensation of movement and a feeling of rotating in space.

stapedectomy

 [sta″pe-dek´tah-me]
surgical removal of the stapes, which is then replaced with a prosthetic device composed of stainless steel, Teflon, or a similar substance. This is done for relief of deafness produced by otosclerosis (fixation of the minute bones of the middle ear). Replacement of the fixed stapes with a device capable of vibrating permits transmission of sound waves from the outer ear to the inner ear so that hearing is restored.



Because the stapes is one of the smallest bones in the body, this procedure is delicate and must be performed under an operating microscope. Very fine instruments are used, designed specifically for this procedure.
Patient Care. The procedure is done under local anesthesia and the patient usually can go home on the first postoperative day. vertigo (dizziness) is common following stapedectomy but it is only temporary. The patient must be protected from falls and self-injury until the sense of balance is regained. Care must also be taken to prevent infection and the patient must be cautioned against blowing the nose and getting water in the ear while bathing until the operative site is completely healed.
Stapedectomy to correct hearing loss caused by otosclerosis. A, Middle ear tissue has been removed. B, Prosthesis is in place.

sta·pe·dec·to·my

(stā'pĕ-dek'tŏ-mē),
Operation to remove the stapes in whole or in part with replacement of the stapes by a metal or plastic prosthesis; used for otosclerosis with stapes fixation to overcome a conductive hearing loss.
[stapes + G. ektomē, excision]

stapedectomy

(stā′pĭ-dĕk′tə-mē, -pē-)
n. pl. stapedecto·mies
Surgical removal of the stapes.

stapedectomy

ENT A middle ear operation in which the footplate of the stapes is partially or completely removed with an argon laser and replaced with a prosthesis Indications Conduction-type hearing loss; the procedure attempts to ↓ conductive deafness to < 10 decibels Complications Cochlear deafness–< 1%, prolonged vertigo, facial nerve injury

sta·pe·dec·to·my

(stā'pĕ-dek'tŏ-mē)
Operation to remove the stapes footplate in whole or part with replacement of the stapes superstructure (crura) by metal or plastic prosthesis; used for otosclerosis with stapes fixation to overcome a conductive hearing loss.
[stapes + G. ektomē, excision]

stapedectomy

An operation to relieve the deafness caused by OTOSCLEROSIS.
References in periodicals archive ?
We retrospectively studied 200 primary stapedectomies performed between 1982 and 1996 by a single surgeon (I.S.).
(7) Based on the outcomes of 38 stapedectomies, he concluded that children with otosclerosis have a high incidence of obliterative disease and that postponing surgery only worsens the footplate pathology, which makes subsequent surgical procedures more difficult.
In 1992, because of the ease of procurement, we began using periosteal bone (femur) as a replacement source in all ossiculoplasties, including tympanoplasties, tympanomastoidectomies, and stapedectomies. At about the same time, we began using the microlathing technique, which has drastically reduced the amount of time spent in the bone laboratory manufacturing ossicles and which has decreased the cost of ossiculoplasty.
He retired from an illustrious career of otology in 1977, after having performed 22,600 ear operations, mostly stapedectomies.
The late Sir Terrence Cawthorne, a prominent surgeon who had performed many stapedectomies, once joked that he had had a sobering dream that someone had found a medical cure for otosclerosis.