Restoring Hearing: What You Need to Know About Stapedectomy Surgery

What Is Stapedectomy Surgery?

Stapedectomy is a surgical procedure that removes the stapes bone in the middle ear and replaces it with a prosthesis. This surgery treats hearing loss caused by otosclerosis (abnormal bone growth prevents the stapes from vibrating properly) cause to conductive hearing loss. Sound waves can again be transmitted effectively to the inner ear and improving hearing. with replacing the immobilized stapes with an artificial device.

Statistics About Stapedectomy Surgery

Global and National Statistics:

1. Success Rate Stapedectomy Surgery:
   • About 80% to 90% of patients experience significant improvement in hearing after a stapedectomy.
   • This procedure results in an improvement of about 20 dB in hearing acuity, especially in speech frequencies.
2. Incidence of Otosclerosis:
   • Otosclerosis (primary condition treated with stapedectomy) effects about 0.3% to 0.4% of the general population.
   • It is more common in women than men with a 2:1 female-to-male ratio.
3. Surgery Frequency:
   • About 6,500 stapedectomy surgeries are performed annually in the United States.
   • Decline in otosclerosis cases in recent years is partially attributed to the measles vaccine because of measles is believed to contribute to the development of otosclerosis.
4. Bilateral Cases:
   • Otosclerosis is bilateral (effecting both ears) in about 80% of cases.

Outcomes and Recovery of Stapedectomy Surgery:

5. Complication Rates:
   • Severe complications (such as profound hearing loss or persistent dizziness) occur in less than 1% of cases.
   • Temporary taste disturbance affects around 20% to 30% of patients but it resolves within a few months.
6. Hearing Improvement Stability:
   • Long-term studies show us hearing improvement remains stable in about 85% to 90% of cases over a decade.

Cost of Stapedectomy Surgery:

7. Cost of Surgery:
   • Costs of stapedectomy surgery change between $5,000 to $10,000 in the United States.
8. Post-Surgical Outcomes:
   • About 10% to 15% of patients may require revision surgery because of complications or insufficient hearing improvement.

Who needs a Stapedectomy Surgery?

Stapedectomy surgery is recommended for people who experiencing conductive hearing loss because of conditions effecting the stapes bone in the middle ear.

Patient for Stapedectomy Surgery:

1. Patients with Otosclerosis
   • Otosclerosis is the primary condition treated with stapedectomy surgery.
2. People with Conductive Hearing Loss
   • This type of hearing loss occurs when sound can’t travel efficiently through the middle ear. Stapedectomy surgery helps by bypassing the fixed stapes bone and restoring sound conduction.
3. Those with Moderate to Severe Hearing Loss
   • Patients often have a significant air bone gap in their hearing tests. (İts meaning there is a measurable difference between air-conducted and bone-conducted sound perception)
4. Patients Unresponsive to Hearing Aids
   • While hearing aids are often the first line of treatment and people who don’t experience sufficient improvement may benefit from a stapedectomy surgery.
5. Good Health Condition
   • Patients should be in good general health and able to tolerate surgery. Pre-existing medical conditions like uncontrolled diabetes or cardiovascular issues may influence the decision to proceed with surgery.
6. Stable Hearing Loss:
   • Patients should have hearing loss that has stabilized over time.

Special Considerations

• Pregnancy: Otosclerosis may worsen during pregnancy because of hormonal changes but surgery is usually delayed until after birth.
• Age: While age isn’t a strict limiting factor, health condition of the patient is more important than chronological age.

How is Stapedectomy Surgery Performed?

1. Preparation

• Pre-Surgical Evaluation:
  Patients undergo thorough assessments, like as audiometry (hearing tests) and imaging (such as a CT scan) for confirm the diagnosis of otosclerosis and evaluate the anatomy of the middle ear.
• Anesthesia:
  Stapedectomy Surgery is generally performed under local anesthesia with sedation or general anesthesia according to the patient’s preference and the surgeon’s recommendation.

2. Surgical Steps

a. Accessing the Ear Canal

• Surgeon uses a microscope to examine the ear canal and make precise incisions.
• Mostly, procedure is performed through the ear canal (transcanal approach) and avoid external incisions.

b. Lifting the Eardrum

• Surgeon gently lifts the eardrum (tympanic membrane) to expose the middle ear structures.

c. Removing the Stapes Bone

• The stapes bone is carefully assessed.
• Surgeon removes the fixed stapes bone with using a micro-drill or laser for leaving its footplate (the base) in place to protect the inner ear.

d. Preparing the Prosthesis

• A small hole is created in the stapes footplate through which the prosthesis will transmit sound vibrations.
• Prosthesis (often made of materials like stainless steel, titanium, or Teflon) is precisely measured and customized to fit the patient’s anatomy.

e. Inserting the Prosthesis

• Prosthesis is placed in the prepared hole and connected to the incus.
• This allows sound vibrations to bypass the immobilized stapes and reach the inner ear.

f. Repositioning the Eardrum

• Eardrum is returned to its normal position and the ear canal could be packed with absorbable material to support healing.

3. Post-Surgical Process

• Bandaging:
  Protective dressing is placed over the ear.
• Recovery Room:
  Patients are fallowed for a few hours before being discharged because of stapedectomy is an outpatient procedure.

4. Recovery and Follow-Up

• Initial Recovery:
  Dizziness, sensation of fullness in the ear or mild discomfort could be seen but usually resolves within a few days.
• Hearing Improvement:
  Hearing may improve immediately after surgery but often stabilizes over several weeks.
• Follow-Up Appointments:
  Surgeon will schedule follow ups to fallow for complications and perform hearing tests to evaluate success of the procedure.

Duration of Surgery

• The procedure takes about 90 minutes to 2 hours.

Modern Techniques

• Some surgeons use advanced tools like laser stapedotomy and it give patients to reduces trauma to surrounding tissues and enhances precision.

What are The Risks of Stapedectomy Surgery?

Common Risks

1. Temporary Dizziness or Vertigo:
   • Many patients experience dizziness or balance issues after surgery because of manipulation of the inner ear.
   • These symptoms are usually temporary and resolve within a few days to weeks.
2. Tinnitus (Ringing in the Ears):
   • Some patients may experience new or worsened tinnitus following the surgery.
3. Altered Taste Sensation:
   • Temporary changes in taste or a metallic taste in the mouth may occur because of irritation or injury to the chorda tympani nerve.
   • This resolves within a few weeks to months.
4. Ear Fullness or Pressure:
   • Patients often feel a sensation of fullness or blockage in the operated ear and so usually diminishes during recovery.

Rare but Serious Risks

1. Hearing Loss:
   • Surgery may result in permanent or total hearing loss in the operated ear In rare cases (about 1%).
2. Facial Nerve Damage:
   • The facial nerve runs close to the middle ear and there is a small risk of injury which could lead to temporary or permanent facial weakness.
3. Infection:
   • Post operative infection is uncommon but could be seen in the ear or surgical site.
4. Perilymph Fistula:
   • Small leak of inner ear fluid (perilymph) may be seen and cause to dizziness, hearing loss or ringing. This can sometimes required additional surgery to repair.
5. Balance Problems:
   • Persistent balance issues beyond the initial recovery period are rare but can occur.
6. Dislocation of the Prosthesis:
   • Prosthesis may become dislodged and cause to a decrease in hearing improvement and necessitating revision surgery in rare cases.
7. Meningitis:
   • Extremely rare but a serious infection like meningitis can result from middle ear surgery if bacteria spread to the brain or spinal cord.

Factors Increasing Risk

• Medical History:
  Pre-existing conditions such as chronic ear infections, severe otosclerosis or a history of previous ear surgery could increase the risk of complications.
• Surgical Experience:
  Skill and experience of the surgeon play a significant role in minimizing risks.

How to Minimize Risks

• Choose a qualified and experienced otolaryngologist (ENT surgeon).
• Follow all pre and post operative instructions like keeping the ear dry and avoiding strenuous activities.

Advices For After Stapedectomy Surgery

1. Follow Post-Surgical Instructions

• Stricty obey to all advice and instructions given by your surgeon. This includes using prescribed medications (like pain relievers or antibiotics) for prevent infection or manage discomfort.

2. Protect Your Ear

• Avoid Water Exposure:
  Keep the operated ear dry during the healing process. Use a shower cap or cotton ball coated with petroleum jelly during showers.
• Avoid Inserting Objects:
  Don’t place cotton swabs, fingers or any objects in your ear.

3. Limit Physical Activity

• Avoid Heavy Lifting:
  Strenuous activities or lifting heavy objects can increase pressure in the middle ear and disrupt healing.
• No Sudden Head Movements:
  Rapid or jerking movements can cause dizziness and strain the healing ear.
• Rest:
  Allow yourself time to recover by getting adequate rest and avoiding stress.

4. Be Cautious with Air Pressure

• Avoid Blowing Your Nose:
  Blowing your nose could increase pressure in the middle ear. Gently dab your nose instead if necessary.
• No Air Travel:
  Flying should be avoided for at least 4–6 weeks to prevent issues with air pressure changes.
• Yawning or Chewing Gum:
  These activities could relieve pressure but should be done cautiously.

5. Monitor for Warning Signs

• Report Unusual Symptoms:
  Contact your surgeon if you experience:
  • Persistent dizziness or vertigo,
  • Severe pain or swelling,
  • Drainage from the ear (especially if it’s yellow or green),
  • Loss of taste that doesn’t improve over time,
  • Worsening hearing or no improvement after several weeks.