Otosclerosis - Stapedotomy
Stapedotomy ή Stapedectomy is the surgical management of otosclerosis.
What is otosclerosis?
It is a hereditary disease that causes hearing loss. It occurs most often in women aged 30-40 and most of the times it affects both ears.
The disease affects the stapes (one of the three bones of the middle ear). Gradually, a fixation is created at the base of the stapes due to the accumulation of calcium salts. This results in a reduction in its mobility or even its complete fixation, which causes hearing loss. The degree of hearing loss is proportional to the reduction in its mobility.
What are the symptoms of otosclerosis?
Hearing loss: Gradually induced hearing loss is called conductive hearing loss because the sound is not conducted, that is, it is not transferred from the middle to the inner ear.
Tinnitus: The intensity of tinnitus is proportional to the degree of the upcoming hearing loss.
Vertigo: It occurs rarely. It usually concerns advanced cases of otosclerosis.
How is otosclerosis diagnosed?
Otomicroscopy and a complete audiological examination are the key factors of diagnosis of otosclerosis. The audiological examination involves an audiogram, tympanogram, acoustic reflexes and a test with tonometers.
In some cases, a CT scan of the temporal bones is also required.
What is stapedectomy / stapedotomy?
Stapedectomy is the surgical procedure used to treat a condition called otosclerosis. Its aim is to replace the bone (staple) immobilized by the disease with a prosthesis. This prosthesis made of titanium successfully restores the mobility of the auditory ossicles, resulting in immediate improvement in hearing. Most often, tinnitus also improves at the same time.
How is the operation performed?
The operation is performed under general anesthesia. It lasts from 1 to 1.5 hours depending on the severity of the disease.
The incision is made inside the ear canal. The stapes is replaced by a special titanium prosthesis.
The patient is hospitalized for one day and is discharged with postoperative instructions and oral antibiotics for a period of 7 days.
What are the complications of stapedotomy?
Postoperative vertigo: is a relatively common complication. It occurs due to irritation of the labyrinth. It is treated with medication and usually resolves in a few days.
Taste disturbance: due to injury to a nerve (chorda of tympani), located next to the eardrum and related to taste. Then a temporary taste disturbance will be caused, but it will recover over time.
Hearing loss: the possibility of hearing deterioration or even deafness (dead ear) after surgery ranges from 1 to 2%.
Tinnitus: most of the time it resolves gradually.
Can I undergo an MRI scan after such an operation?
The special titanium prosthesis used is completely demagnetized. This means that the patient can safely undergo an MRI scan that will be needed to diagnose any other medical condition that may occur later in life.
What are the postoperative instructions after stapedotomy?
Postoperatively for at least 1 month, the patient should avoid the following:
- Avoid water in the ear
- Weight lifting and intense sports activity
- Sneezing
- Travel by plane
- Persistent cough
- Forceful nose blowing
- Constipation
- Avoid sudden movements
When is the follow-up performed?
The follow-up is done 3 times postoperatively:
- In 7 days: Suture and gauze removal from the external auditory canal is performed
- In 20 days: Aural toilet and audiogram are done
- In 2 months: Re-evaluation and complete audiological examination are done
How much sick leave is required?
Depending on the type of work, sick leave of one to three weeks is granted.
Is it possible to avoid surgery to treat otosclerosis?
The operation should be avoided in the following cases:
- Otosclerosis that affects one ear, while there is complete deafness in the other ear
- The patient does not wish or is afraid of surgery.
- There is significant damage/degeneration of the auditory nerve (mixed or sensorineural hearing loss).
- Inability to operate due to the presence of other serious diseases in the patient.
How can the disease be treated in these cases?
The placement of one or two hearing aids offers a solution in these cases.
The administration of medication (sodium fluoride) is not a treatment of choice. This treatment has been abandoned internationally due to its ineffectiveness and possible complications.