Otosclerosis surgery: what to know about stapedotomy procedure
Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, leading to hearing loss due to the fixation of the stapes bone. To address this, surgical interventions such as stapedectomy and stapedotomy have been developed. In a traditional stapedectomy operation, the entire stapes bone is removed and replaced with a prosthesis to restore the transmission of sound vibrations to the inner ear. Alternatively, the stapedotomy procedure involves creating a small opening in the fixed stapes footplate and inserting a prosthetic device, which has been associated with fewer complications and improved hearing outcomes. These surgical options have significantly improved the quality of life for individuals affected by ear otosclerosis. Read our article and learn everything about stapedotomy.
What is the stapedotomy procedure?
A stapedotomy is a surgical procedure designed to improve hearing in individuals with otosclerosis—a condition where abnormal bone growth immobilizes the stapes bone in the middle ear, leading to conductive hearing loss. This procedure is a refined version of the traditional stapedectomy surgery. In a stapedectomy operation, the entire stapes bone is removed and replaced with a prosthesis. In contrast, a stapedotomy involves creating a small opening in the fixed stapes footplate, allowing for the insertion of a prosthetic device that restores the transmission of sound vibrations to the inner ear. The stapedotomy procedure typically begins with the surgeon making an incision in the ear canal to access the middle ear. The stapes bone's superstructure is then removed, and a precise perforation is made in the footplate, often using a laser or micro-drill. A piston-like prosthesis is subsequently inserted into this opening and connected to the incus bone, re-establishing the ossicular chain's continuity. An alternative technique known as reverse stapedotomy has been developed to minimize potential complications associated with the conventional approach. In this method, the sequence of surgical steps is altered: the stapedotomy hole is created before removing the stapes superstructure. This modification aims to reduce the risk of footplate fractures and incus dislocations, thereby enhancing surgical outcomes. Overall, the stapedotomy procedure, including its reverse technique, offers a high success rate in restoring hearing for patients with otosclerosis. The choice between a traditional stapedectomy operation and a stapedotomy depends on various factors, including the surgeon's expertise and the patient's specific condition. Consultation with an experienced otologic surgeon is essential to determine the most appropriate surgical approach.
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What is otosclerosis disease in the ear?
Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, leading to progressive hearing loss. This disorder primarily affects the stapes bone, one of the three tiny ossicles responsible for transmitting sound vibrations to the inner ear. In otosclerosis, the stapes becomes fixed due to this irregular bone remodeling, hindering its ability to vibrate and thereby disrupting sound transmission. The exact cause of otosclerosis remains uncertain, but it is often linked to genetic factors, as the condition tends to run in families. Hormonal changes, particularly during pregnancy, may also play a role in its development. The condition is more prevalent among white, middle-aged women. Symptoms typically begin with gradual hearing loss, initially affecting the ability to hear low-pitched sounds or whispers. As the disease progresses, higher frequencies may also be impacted. Some individuals experience tinnitus—a ringing or buzzing in the ears—and, less commonly, dizziness or balance issues. Diagnosis involves a thorough examination by an otolaryngologist, including hearing tests such as audiometry to assess the degree of hearing loss. Imaging studies like CT scans may be utilized to evaluate the extent of bone involvement. Treatment options vary based on the severity of the condition. Hearing aids can amplify sound for those with mild to moderate hearing loss. In cases where hearing loss is more severe or unresponsive to hearing aids, surgical intervention, such as a stapedectomy, may be performed to replace the immobilized stapes with a prosthetic device, thereby restoring sound conduction.
Otosclerosis surgery: what you need to know
Can I have surgery on both ears?
What does the surgery involve?
What happens if I don’t have surgery?
Hearing mechanism and otosclerosis
Otosclerosis disease: causes
1. Genetic Factors
- Otosclerosis is often hereditary, meaning it can be passed down through families.
- It follows an autosomal dominant inheritance pattern, meaning a person with an affected parent has a 50% chance of developing the condition.
- Not everyone with the genetic mutation develops symptoms, indicating that other environmental or biological factors may also influence its onset.
2. Viral Infections
- Some studies suggest that viral infections, particularly the measles virus, may trigger otosclerosis.
- Measles virus RNA has been found in the small bones in the ear of affected individuals, supporting the theory that a viral infection could cause abnormal bone growth.
3. Hormonal Influences
- Otosclerosis is more common in women than men and often worsens during pregnancy.
- This suggests that hormonal changes, particularly estrogen, might affect bone metabolism and contribute to the excessive bone growth seen in otosclerosis.
4. Autoimmune Factors
- Some researchers believe that otosclerosis could be linked to immune system dysfunction, which may cause abnormal bone remodeling in the small ear bones.
- Certain immune system markers have been detected in affected individuals, but more research is needed to confirm this connection.
5. Environmental Factors
- Loud noise exposure may accelerate hearing loss in individuals predisposed to otosclerosis.
- Fluoride deficiency has been explored as a potential risk factor, though studies have yet to confirm a direct link.
6. Abnormal Bone Remodeling
- Otosclerosis occurs when the normal process of bone turnover in the small bones of the ear becomes disrupted.
- Instead of balanced bone breakdown and formation, excessive bone growth develops around the stapes, causing it to stiffen and reducing sound transmission to the inner ear.
Who is at Risk?
- Age: Symptoms typically appear between ages 15 and 45.
- Gender: More prevalent in women, particularly during pregnancy.
- Genetics: A family history of otosclerosis increases the risk.
- Ethnicity: More common in Caucasians than other populations.
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Otosclerosis treatments: surgery, hearing aids and more
There is no cure for otosclerosis, but three primary treatment options exist to help manage hearing loss.
- No intervention – If the hearing loss is mild, treatment may not be necessary. Some individuals may adapt to the gradual changes in hearing without requiring immediate assistance. However, regular monitoring by an audiologist is recommended to track progression.
- Hearing aids – These devices amplify sounds and can significantly improve hearing ability, making speech and environmental sounds clearer. Modern hearing aids, such as those from Oticon UK, offer advanced technology to enhance sound quality and speech recognition, helping individuals maintain communication and daily activities.
- Surgery (Stapedotomy or Stapedectomy) – For those experiencing significant hearing loss, surgical intervention may be the best option. This procedure involves replacing the immobilized stapes bone with an artificial implant to restore sound conduction. Stapedotomy is a minimally invasive version of the surgery, while stapedectomy involves complete removal of the stapes. Both procedures have high success rates in improving hearing.
Since otosclerosis is a progressive condition, early diagnosis is key to selecting the most suitable treatment. Consultation with an ENT specialist or audiologist can help determine the best approach based on individual hearing needs.
Otosclerosis symptoms: signs of hearing loss
Otosclerosis is a progressive condition that affects the bones in the middle ear, leading to hearing loss.
- The most common symptom is gradual hearing loss, typically beginning in one ear and often progressing to both. This hearing loss usually starts with difficulty hearing low-pitched sounds or whispers and may worsen over time.
- Many individuals with otosclerosis experience tinnitus, a persistent ringing, buzzing, or humming sound in the ears. While not always present, tinnitus can be bothersome and impact concentration or sleep.
- Another common symptom is paracusis of Willis, where individuals hear better in noisy environments. This occurs because background noise prompts people to speak louder, making it easier for someone with otosclerosis to hear them.
- Some individuals may also develop balance issues or dizziness if the abnormal bone growth extends into the inner ear, affecting the vestibular system. However, this is less common.
- Symptoms of otosclerosis typically appear between the ages of 15 and 45, with women more frequently affected, especially during hormonal changes such as pregnancy. If you notice signs of hearing loss or tinnitus, consulting an audiologist or ENT specialist is essential for early diagnosis and appropriate management.
How to spot otosclerosis: audiogram, otoscopy...
Diagnosing otosclerosis requires a combination of clinical evaluation and specialized hearing tests.
- The first step is a comprehensive hearing assessment, which includes an otosclerosis audiogram. This test typically reveals conductive hearing loss, especially in the lower frequencies, and a characteristic dip at 2000 Hz, known as Carhart’s notch, which suggests stapes fixation.
- Another essential examination is otosclerosis otoscopy, where an ENT specialist inspects the eardrum. While the eardrum often appears normal, in some cases, a reddish hue called Schwartze’s sign may be visible, indicating increased blood flow due to active bone remodeling.
- Acoustic reflex in otosclerosis is also a key diagnostic marker. This test measures the involuntary muscle response of the middle ear to loud sounds. In otosclerosis, the stapedial reflex is usually absent or elevated due to the fixation of the stapes bone, which prevents normal movement.
- A tympanometry test helps assess middle ear function. The otosclerosis tympanogram type is typically Type A or As, showing normal or slightly reduced eardrum mobility but without middle ear fluid, distinguishing it from other causes of conductive hearing loss.
Early detection through these tests allows for appropriate treatment, including hearing aids or surgery, to manage hearing loss effectively.
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Stapedotomy steps and procedure
Preparation for Surgery
Surgical Procedure
Stapedotomy steps
- Stapedotomy surgery is a procedure performed to restore hearing by improving sound transmission to the inner ear. It involves removing part of the stapes bone, the innermost of the three middle ear bones (malleus, incus, and stapes), and replacing it with a prosthetic implant. This procedure is often referred to as stapedectomy, though stapedectomy typically involves the complete removal of the stapes, while stapedotomy creates a small opening in the stapes footplate.
- Stapedotomy is commonly used to treat otosclerosis, a condition where abnormal bone growth hardens around the base of the stapes, preventing proper sound conduction. By inserting a prosthesis, the surgery allows sound vibrations to reach the inner ear more effectively, improving hearing.
Stapedotomy Surgery | Stapedectomy Surgery |
|---|---|
| 1. The tympanic membrane (eardrum) is elevated. |
1. The tympanic membrane (eardrum) is elevated. |
| 2. The ossicular chain is tested for movement. |
2. The stapes bone is completely removed. |
| 3. A small opening is created in the stapes footplate. |
3. A vein graft is placed over the footplate opening. |
| 4. A prosthesis is attached to the incus. |
4. A prosthesis rests on the vein graft. |
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Laser stapedotomy
- Laser stapedotomy is a modern surgical procedure used to treat otosclerosis, a condition where abnormal bone growth in the middle ear causes hearing loss. This surgery replaces the immobilized stapes bone with a prosthesis, allowing sound waves to reach the inner ear effectively.
- Unlike traditional stapedotomy, which uses manual drilling, the laser technique provides greater precision, minimizing trauma to surrounding tissues. One of the key advantages of laser stapedotomy is its ability to create a controlled and precise opening in the stapes footplate, reducing the risk of complications such as inner ear trauma and excessive bleeding. The procedure is minimally invasive, typically performed under local or general anesthesia, and lasts about 60–90 minutes.
- Laser Stapedotomy Recovery: Recovery from laser stapedotomy is generally quick, with most patients returning to normal activities within one to two weeks. Initial dizziness or mild imbalance is common but subsides within days. Patients must avoid loud noises, heavy lifting, and sudden head movements during the healing period. Hearing improvement is usually noticeable within a few weeks, but full benefits may take one to three months as swelling resolves. A follow-up visit ensures proper healing and optimal hearing restoration.
Skeeter drill stapedotomy
- Skeeter drill stapedotomy is a surgical technique used to treat otosclerosis, a condition where abnormal bone growth around the stapes impairs sound transmission, leading to progressive hearing loss. This procedure involves creating a small opening in the stapes footplate to allow the placement of a prosthesis, restoring sound conduction to the inner ear.
- Unlike traditional stapedotomy methods, which may use manual perforators or lasers, the Skeeter drill is a high-speed micro-drill that provides greater precision in creating the opening. This drill minimizes thermal damage to the inner ear, reducing the risk of complications such as vertigo or sensorineural hearing loss. Surgeons favor the Skeeter drill for its ability to provide better control, ensuring a clean and accurate perforation without excessive trauma to surrounding structures.
- Benefits and Recovery: The Skeeter drill stapedotomy is a minimally invasive procedure with a high success rate in improving hearing. Patients typically experience minimal post-operative discomfort, and recovery is relatively quick, with most returning to normal activities within one to two weeks. While mild dizziness or imbalance may occur initially, it usually subsides within a few days. Regular follow-up with an ENT specialist ensures proper healing and optimal hearing restoration.
Stapedotomy surgery: success rate and complications
The primary goal of the surgery is to improve hearing. Approximately 80% of patients experience hearing improvement after the procedure. While the surgery has a high success rate, complications, though rare, may include hearing loss (in 1-2% of cases, total loss in the operated ear), dizziness (which may persist in some cases), facial nerve damage (extremely rare but could cause temporary facial weakness), taste disturbances (affecting one side of the tongue, usually temporary), and tinnitus (ear ringing, which often improves as healing progresses).
Potential Complications
While rare, there are risks associated with the surgery, including:
Hearing loss
In approximately 10% of patients undergoing surgery, hearing improvement may be minimal. In rare cases, inner ear damage can lead to further hearing deterioration, occurring in about 5% of cases. In the most severe instances, this can result in profound or total hearing loss in the operated ear (commonly referred to as a "dead ear"), rendering a hearing aid ineffective. For highly experienced surgeons, this complication is rare, affecting only about 1 in 100 patients. As a precaution, surgery is usually performed first on the ear with poorer hearing.
Dizziness and balance issues
Mild dizziness is common immediately after surgery and may be accompanied by nausea or vomiting. Unsteadiness can persist for a few days, while dizziness triggered by sudden head movements may last for several weeks. In rare cases, prolonged balance disturbances occur.
Taste changes
The taste nerve, located near the eardrum, may be stretched or, in some cases, damaged during surgery. This can lead to an altered taste sensation on one side of the tongue. While usually temporary, about 10% of patients may experience permanent taste disturbances.
Tinnitus (Ear Noise)
Some patients may develop tinnitus (ringing or buzzing in the ear) after surgery, particularly if their hearing worsens post-operatively. However, those who had tinnitus due to otosclerosis before surgery often notice an improvement. The risk of new tinnitus developing remains low.
Facial nerve injury
The facial nerve, responsible for controlling facial muscles, passes through the ear. While extremely rare, temporary facial weakness may occur following surgery. Permanent facial paralysis is exceptionally uncommon. If it happens, it can affect eye closure, smiling, and forehead movement, with recovery ranging from partial to complete.
Allergic reactions
Some patients may develop an allergic reaction to the medication in ear dressings, leading to itching or swelling. If this occurs, seek medical advice from your surgeon. These dressings are used to prevent infection.
Other considerations
A complete loss of hearing, balance disturbances, or taste dysfunction can impact certain professions. It is advisable to discuss any occupational concerns with your specialist. Some experts also recommend avoiding activities such as scuba diving, skydiving, or the use of firearms after stapedotomy surgery.
General anaesthetic risks
The procedure is typically performed under general anaesthesia, which carries risks such as blood clots (deep vein thrombosis), pulmonary embolism, heart attack, chest infection, stroke, or, in extremely rare cases, death. Your anaesthetist will explain the procedure, associated risks, and necessary precautions during your pre-assessment.
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Eardrum scars after otosclerosis surgery
Causes of Eardrum Scarring
Eardrum scars typically develop due to:
- Surgical procedures: Any ear surgery involving the tympanic membrane can cause scarring, particularly if repeated operations are needed.
- Chronic ear infections: Recurring infections can lead to inflammation, thickening, and eventual scarring of the eardrum.
- Ear trauma: Injuries such as eardrum perforation or aggressive cleaning with cotton swabs can damage the membrane.
- Tympanostomy tubes: Insertion of ear tubes to treat fluid buildup can sometimes result in minor scarring after removal.
Effects of Eardrum Scarring on Hearing
- Mild cases: Minor scarring usually does not affect hearing and often goes unnoticed.
- Severe cases: Extensive scarring may stiffen the eardrum, reducing its ability to vibrate and conduct sound, leading to conductive hearing loss.
- Associated symptoms: Some individuals may experience tinnitus (ringing in the ears) or a feeling of fullness in the ear.
Diagnosis and Treatment
- Otolaryngologists (ENT specialists) diagnose eardrum scarring using an otoscope or tympanometry to assess eardrum movement.
- Treatment is often unnecessary if hearing is not significantly affected.
If hearing loss occurs, options include:
- Hearing aids to amplify sound.
- Surgical intervention (myringoplasty or tympanoplasty) to repair severe scarring.
- Steroid treatments or ear drops to manage inflammation in mild cases.
Prevention and Care
To minimize the risk of eardrum scarring after surgery:
- ✅ Follow post-surgical care guidelines (keeping ears dry, avoiding infections).
- ✅ Avoid aggressive ear cleaning and loud noise exposure.
- ✅ Seek early treatment for ear infections to prevent complications.
Conclusion
Stapedotomy recovery: time and guidelines
Recovery varies, but most patients experience temporary dizziness or imbalance in the first few days. Hearing improvement may take several weeks as swelling subsides. Post-surgery care is essential for optimal recovery. Patients are advised to rest for 24-48 hours, keep the ear dry, and avoid heavy lifting, sudden movements, strenuous activities, flying, and loud noises. Forceful sneezing or nose-blowing should also be avoided. A follow-up appointment is scheduled within three weeks to monitor healing and assess hearing improvement.
Post-Surgical Care and Recovery
- After surgery, a bandage may be placed around the head and removed within 4-24 hours, depending on the surgeon’s recommendation. Patients may experience mild discharge from the ear, which should be managed with daily dressing changes.
Recovery guidelines include:
- Resting for 24-48 hours post-surgery.
- Keeping the ear dry while bathing.
- Engaging in light activities and avoiding vigorous exercise.
- Avoiding sudden head movements, heavy lifting, and flying.
- Preventing forceful sneezing or nose-blowing.
- A follow-up outpatient appointment is scheduled within three weeks post-surgery. Patients should consult their doctors for personalized advice and further care instructions.
This information serves as a general guide, and each patient’s needs should be discussed with medical professionals before and after surgery.
Ideal candidates of stapedotomy
The procedure is most suitable for individuals with moderate to severe conductive hearing loss due to otosclerosis and who are otherwise in good health with no active ear infections. Overall, otosclerosis surgery offers significant hearing restoration for most patients, making it a valuable option for those struggling with hearing impairment. A consultation with an ENT specialist is essential to determine eligibility and discuss potential outcomes.
What is the benefit of having surgery?
A successful stapedectomy typically restores sufficient hearing in the operated ear, reducing or eliminating the need for a hearing aid. If only one ear is affected, the procedure can enhance sound localization and improve the ability to distinguish speech in noisy environments. When both ears are affected, surgery is generally performed on the ear with the greater hearing loss first. However, a hearing aid may still be necessary for the non-operated ear to achieve the best overall hearing experience.
After the surgery: how long will I stay in the hospital?
What to expect after surgery
Recovery period
Stapedectomy vs stapedotomy: difference
Stapedectomy and stapedotomy are surgical procedures employed to address conductive hearing loss caused by otosclerosis, a condition where abnormal bone growth immobilizes the stapes bone in the middle ear. Both surgeries aim to restore the transmission of sound to the inner ear by replacing or bypassing the immobilized stapes with a prosthesis.In a traditional stapedectomy, the entire stapes footplate is removed and replaced with a prosthesis. Conversely, a stapedotomy involves creating a small, precise opening in the fixed stapes footplate, often using a laser, through which a prosthesis is inserted. This less invasive approach preserves more of the natural anatomy of the ear. Clinical studies have compared the outcomes of these procedures. Research indicates that stapedotomy may offer better initial and long-term hearing improvement at higher frequencies compared to stapedectomy. Additionally, stapedotomy is associated with a reduced risk of complications, such as perilymph fistula, which is a leakage of inner ear fluid. Despite these differences, both procedures have been shown to provide satisfactory and stable long-term hearing results. The choice between stapedectomy and stapedotomy often depends on the surgeon's experience and the specific anatomical considerations of the patient. Importantly, the success of either surgery is significantly influenced by the surgeon's skill and familiarity with the chosen technique.
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Stapedectomy surgery cost in the UK
Post op stapedotomy advice in the UK
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