Stapedectomy - Signs, Symptoms, Treatment

Stapedectomy Details

Stapedectomy is a procedure performed on the middle ear to improve hearing. In this procedure the innermost bone (stapes) of the middle ear is removed, and replaced with a small plastic tube surrounding a short length of stainless steel wire called prosthesis. This helps in restoring more normal hearing.

The Stapes bone is present in the middle ear which is involved in the conduction of sound vibrations to the inner ear, Stapedectomy is performed on the middle ear, this procedure does not require any incisions outside the body, as the entire procedure is performed through the ear canal. The procedure is performed under local or general anaesthesia, so that the patient does not feel any pain. 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.

Before Stapedectomy

Diagnosis is required for which certain hearing tests have to be conducted by an ear specialist (audiologist or otologist). Two most common tests done for this are Weber's test and Rinne's test. Apart from these CT scans or X-ray study of the head may also be done to know more about it. These tests are non-invasive and cause no pain.  

How it is performed

Your ear is divided into three parts, outer ear which consists of pinna and auditory canal, middle ear which consists of three bones (Malleus, Incus and Stapes) and the inner ear which consists of chochlea. Stapedectomy is performed through the ear canal with the help of specially designed microscope and instruments. Your doctor will make an incision in the lining of the auditory canal and will extend that to the ear drum or tympanic membrane. The incision will extend around the tympanic membrane to set it free, and this allows it to be lifted and thus leaves middle ear exposed.After exposing the middle ear, your surgeon will scrape out the extra bone tissue to clear the field of view while ensuring no damage being done to the nerve carrying taste inputs to your tongue.

Stapedectomy is performed through the ear canal with the help of specially designed microscope and instruments. Your doctor will make incision in the lining of auditory canal and will extend that to the ear drum or tympanic membrane. The incision will extend around the tympanic membrane to set it free and this allows it to be lifted and thus leaves middle ear exposed.After exposing the middle ear your surgeon will scrape out the extra bone tissue to clear the field of view while ensuring no damage being done to the nerve carrying taste inputs to your tongue.

After exposing the middle ear your surgeon will scrape out the extra bone tissue to clear the field of view while ensuring no damage being done to the nerve carrying taste inputs to your tongue. After stapes has been exposed, your doctor will use laser to set it free from Incus and finally will also release it from its footplate. Footplate helps in transmitting audio signals from middle ear to inner ear. Your surgeon will now make a hole in the footplate , the prosthesis will now be placed into the fooplate and the other end will be clipped to incus (the middle bone). After the prosthesis has been secured, your surgeon will put tympanic membrane back to its previous position and will secure its position with the help of absorbable gelatin bandage.

Recovery

The patient is requested to follow the instructions given by the doctor; It is extremely important that the patient must avoid getting the ear wet until it has completely healed. Water in the ear could cause an infection, which could lead to a complete hearing loss, therefore be cautious while taking shower, put cotton balls in the ear or wrap your ear by a plastic.

The ear is quite sensitive right after the surgery, so the patient should avoid loud music until the ear retrains itself to hear sounds properly. The patient will also have some follow up appointments, it is recommended not to miss any of them.

Potential Risks

The goal of performing stapedectomy is to give you the best hearing possible with the least risk of failure. But like other aspects of life, there are no guarantees of success. Possible risk factors could be:

  • Facial Nerve Paralysis: The facial nerve controls movement on one side of the face and runs through the ear. A temporary paralysis occurs in less than 1% of patients after surgery. Permanent paralysis is very rare, occurring in less than 1 out of 1,000 patients.
  • Perforation: In less than 10% of patients a small tear in the eardrum can occur. This normally heals without further difficulty.
  • Taste Disturbance: The nerve that supplies one third of the taste to the tongue runs through the middle ear and may have to be pushed aside or cut in order to do ear surgery. Therefore, temporary taste disturbance can occur.
  • Dizziness: Temporary dizziness, lasting up to a month, occurs commonly after stapedectomy. However in less than 1% of patients, dizziness can be severe and long lasting

Additional Information

Stapedectomy is a very safe procedure with a relatively low rate of complications. With regard to hearing, about 2% of patients may have additional hearing loss in the operated ear following a stapedectomy; less than 1% lose hearing completely in the operated ear. About 9% of patients experience disturbances in their sense of taste.

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