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In a normal ear, the outer ear, called the "auricle," funnels vibrating air molecules -- sounds -- through the ear canal to the ear drum. The ear drum's movements are transferred to small bones in the middle ear called "ossicles." One of these bones is the stapes -- the smallest bone in the human body. The stapes bone, commonly called the "stirrup," vibrates in and out of the oval window, which creates "ripples" in the inner ear fluids. This fluid movement stimulates the fine sense organs of the inner ear which, in turn, stimulate the auditory (hearing) nerve. The auditory nerve carries sound energy to the brain.
Otosclerosis is an abnormal, microscopic bone growth in the walls of the inner ear. This growth causes the stapes bone to become frozen in place or fixed to the surrounding bone. When the stapes becomes frozen or fixed, it cannot vibrate freely to transmit sound waves to the inner ear fluids. Hearing is impaired.
Surgery is the best way to improve hearing loss caused by otosclerosis. (Although most patients can successfully wear a hearing aid, natural hearing is preferred. Unfortunately, no medication has been proven to be effective.)
Various surgical treatments have been available for about 45 years. The first operation to treat otosclerosis was called the "fenestration procedure." It required that the doctor perform mastoid surgery as well as create an artificial opening in another part of the inner ear. The attention of ear surgeons later focused on the diseased stapes itself, and the "stapes mobilization procedure" was developed. With this improvement in surgical technique, the treatment of choice became the stapedectomy. Doctors first performed this operation in 1956.
During a stapedectomy (which is performed under either local or general anesthesia), doctors remove the diseased bone and replace it with an artificial substitute. Surgery usually takes place entirely through the ear canal, so the doctor avoids having to make any outer incisions.
The surgeon performs the stapedectomy using an operating microscope. The surgeon first folds approximately half the ear drum forward to reach the stapes area then uses fine instruments to remove the superstructure, or stirrup portion, of the stapes. Doctors employ several methods to manage the "fixed stapes footplate" properly. Usually, they make a small opening through the fixed plate with fine instruments, a micro drill, or a laser. In some cases, they remove the entire footplate. Surgeons use a variety of artificial stapes or "prostheses" to replace the diseased bone. The most common prosthesis is called a "piston." It attaches to the incus and inserts into the vestibule of the inner ear, thus bypassing the fixed stapes footplate.
An ear specialist must give you a thorough examination and hearing test to determine if you are a candidate for the operation. There are many causes of deafness. Not all patients with otosclerosis are candidates for stapedectomy.
The possibility of obtaining a good result from this operation is about 90 percent. In other words, about nine out of ten patients will notice a hearing improvement to the maximum capability of their inner ear -- if the inner ear functions normally, the surgery restores nearly normal hearing.
Approximately seven percent of all patients recover only part of their hearing and two percent remain at the same hearing level. The main risk of the stapedectomy procedure is a one-percent chance of developing inner ear hearing loss due to factors that doctors do not yet entirely understand. For this reason, the surgeon operates on only one ear at a time and always does the worst ear first.
Doctors usually perform stapedectomy on an outpatient basis. During the preoperative visit, the doctor speaks with you about your medical history, your physical examination, the details of the procedure, and risks and benefits. At this time, you should identify the medication you are taking, including dosage and frequency. You should also describe any known drug allergies. If you have symptoms of a cold one week or less before your operation, report these symptoms at once to your doctor.
Following the stapedectomy procedure, most patients can go home that evening or the next morning. The evening after the operation, lie quietly on the unoperated ear. Do not be alarmed if you have some dizziness for the first few days.
During surgery, the surgical team places a packing in your ear canal. You will not notice an improvement in your hearing until the doctor or nurse removes the packing one week after surgery. It often takes one to two weeks for hearing to reach its maximum level of improvement. Initially, many patients complain of a "hollow" sensation of sound, as though they were hearing from the bottom of a barrel or in a cave. Sounds may have a harsh, shrill quality or may seem very loud, but they will gradually become normal.
Because a small taste nerve (the chorda tympani) runs through the ear, it is not unusual for patients to experience altered taste sensations for several weeks or months following the stapedectomy. Normal taste sensations usually return eventually.
The ear drum will heal quickly. Two weeks following surgery, you may resume normal activities, including flying. Until then, avoid blowing your nose for one week after surgery, and keep water out of your ear for at least two weeks. When you shampoo or shower, place a cotton ball covered lightly with petroleum jelly into your outer ear canal. Do not go swimming. Your doctor may give you a prescription for antibiotics to be taken orally.
Complications are very rare. If at any time after surgery you experience sudden hearing loss, pain, dizziness, or any new symptom related to the operated ear, notify your doctor immediately. Early intervention can avert problems.
It is important to have periodic hearing tests following your stapedectomy operation. From these tests, your doctor obtains accurate information on results of your surgery, the status of your unoperated ear, and the possible benefit of surgery if the unoperated ear is later affected by otosclerosis.
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