Stapedectomy – An overview
A stapedectomy surgery is a form of minimally invasive surgical procedure that is useful in treating a number of conditions that affect a person’s middle ear. This surgery is performed through the ear canal and requires local, or general, anesthesia.
Need for a Stapedectomy
You may require a stapedectomy, if you:
- Suffering from a steady loss in hearing (fixation of the stapes)
- Suffering from a bone gap of at least 30 dB
- have Carhart’s notch in the audiogram with relative conducive hearing loss
- have a good cochlear reserve determined sue to good speech discrimination
Risks associated with Stapedectomy
There are several rare risks of complications of arising after a stapedectomy surgery, such as:
- Vertigo in the immediate post-operative time period
- facial palsy
- Nausea and vomiting
- Perilymph gush
- Floating foot plate
- Tympanic membrane tear
- Dead labyrinth
- Perilymph fistula
In case the stapedectomy is performed in the middle ear with a congenitally fixed foot plate, the results may vary but the risk of hearing damage is increased after the stapes bone is removed and replaced (for otosclerosis).
Stapedectomy Surgery procedure
A stapedectomy surgery procedure is one of the most delicate and intricate surgical procedures as these are performed in the middle ear which is surrounded by delicate and extremely-sensitive tissues.
A stapedectomy is required when the ‘stapes’ footplate is fixed into position instead of being mobile as is seen in normal conditions. This condition may result in gradual hearing loss. This condition may be caused due to otosclerosis, which causes abnormal mineralization of the temporal bone or it could be a result of the congenital (birth) malformation of the stapes bone.
It is possible to use a stapedectomy procedure in order to improve the hearing ability caused due to these factors by replacing the stapes bone with a micro-prosthesis. This procedure may also require making a small hole in the fixed stapes footplate and inserting a very small piston-shaped prosthesis, called a stapedotomy.
The surgical procedure requires making an incision in the ear canal close to the ear drum. The surgeon will carefully raise the ear drum and use a laparoscopic microscope in order to view the inner ear structure in more detail. The next step involves opening the middle ear and the inner bones are evaluated to determine the presence of otosclerosis.
In case the surgeon can observe calcium deposits the stapes bone is then tested for mobility. The surgeon will then cut and separate the stapes bone from the incus (anvil) in the middle ear.
After the incus and the hammer (malleus) bones are freed from the fixed stapes, these can be freely moved when pressure is applied. The surgeon will use advanced technology such as laser or other micro-instruments to dissolve the tendon and the arch of the stapes bone, while the remaining of the stapes bone is removed completely.
The next step requires the surgeon to open the window of bone between the inner ear and the middle ear to allow the surgeon to make another small (0.6 mm) opening in the inner ear.
Once the hole is made, the surgeon will then insert prosthesis (artificial bone) into the incus bone and gently insert it in place. The surgeon will use a piece of fat, or other soft tissue, from a small incision behind the ear in order to help close the space in the window around the prosthesis.
Advantages of Stapedectomy surgery
A stapedectomy surgery is considered to be an ideal treatment method for treating a number of disorders and diseases that cause loss of hearing due to the fixation of the stapes footplate especially. This surgery is performed using the latest minimally invasive surgical techniques in order to avoid pain and discomfort to the patient as well as to make the surgery more effective, efficient and convenient.