A stapedectomy is a surgical procedure of the middle ear performed in order to improve hearing. If the stapes footplate is fixed in position, rather than being mobile a conductive hearing loss results. There are two major causes of stapes fixation; the first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy, or creating a small hole in the fixed stapes footplate and inserting a tiny, piston-like prosthesis - a stapedotomy; the results of this surgery are most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with improved hearing while less than 1% will experience worsened hearing acuity or deafness. Successful surgery provides an increase in hearing acuity of about 20 dB.
That is as much difference as having your hands over both ears, or not. However, most of the published results of success fall within the speech frequency of 500 Hz, 1000 Hz and 2000 Hz. Indications of stapedectomy: Conductive hearing loss. Air bone gap of at least 30 dB. Presence of Carhart's notch in the audiogram of a patient with conductive hearing loss Good cochlear reserve as assessed by the presence of good speech discrimination. Contraindications for stapedectomy: Poor general condition of the patient. Only hearing ear. Poor cochlear reserve as shown by poor speech discrimination scores Patient with tinnitus and vertigo Presence of active otosclerotic foci as evidenced by a positive flemmingo sign. Conductive deafness due to Ehlers-Danlos Syndrome Complications of stapedectomy: Facial palsy Vertigo in the immediate post op period Vomiting Perilymph gush Floating foot plate Tympanic membrane tear Dead labyrinth Perilymph fistula Labyrinthitis Granuloma TinnitusWhen a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of hearing damage is greater than when the stapes bone is removed and replaced.
This is due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists a perilymphatic gusher may occur when the stapes is removed. Without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively. In 1995, Glasscock et al. published a 25-year single-centre review of over 900 patients who underwent stapedectomy and stapedotomy and found complications rates as follows: reparative granuloma 1.3%, tympanic membrane perforation 1.0%, total sensorineural hearing loss 0.6%, partial sensorineural hearing loss 0.3%, vertigo 0.3%. In this series, there was no incidence of tinnitus. A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and reduce the chances of postoperative complications. In stapedotomy, instead of removing the whole stapes footplate, a tiny hole is made in the footplate - either with a microdrill or with a laser, a prosthesis is placed to touch this area with movement of the tympanic membrane.
This procedure can be further improved by the use of a tissue graft seal of the fenestra, now common practice. Laser stapedotomy is a well-established surgical technique for treating conductive hearing loss due to otosclerosis; the procedure creates a tiny opening in the stapes in. The CO2 laser allows the surgeon to create small placed holes without increasing the temperature of the inner ear fluid by more than one degree, making this an safe surgical solution; the hole diameter can be predetermined according to the prosthesis diameter. Treatment can be completed in a single operation visit using anesthesia followed by one or two nights' hospitalization with subsequent at-home recovery time a matter of days or weeks. Comparisons have shown stapedotomy to yield either as good or better results than stapedectomy, to be less prone to complications. In particular, stapedotomy procedure reduces the chance of a perilymph fistula. Stapedotomy, like stapedectomy, can be successful in the presence of sclerotic adhesions, provided the adhesions are removed during surgery.
However, the adhesions may recur over time. The stapedotomy method is not applicable in those rare cases that involve scleroris of the entire ossicular chain; because it is a simpler and safer procedure, stapedotomy is preferred to stapedectomy in the absence of predictable complications. However, the success rate of either surgery depends on the skill and the familiarity with the procedure of the surgeon. Furthermore, a major success factor in both surgeries is determining the length of the prosthesis; the world's first stapedectomy is credited to Dr. John J. Shea Jr. who performed it in May 1956 on a 54-year-old housewife who could no longer hear with a hearing aid. Significant contributions to modern stapedectomy techniques were made by the late Dr. Antonio De La Cruz of the House Ear Institute in Los Angeles.