Stapedectomy

A stapedectomy is a surgical procedure that involves the removal of part or all of the stapes bone, one of the bones in the middle ear, and its replacement with a prosthetic device.

Indications for Stapedectomy

• Otosclerosis: a condition where abnormal bone growth in the middle ear causes hearing loss
• Stapes bone fixation: when the stapes bone becomes fixed in place and is unable to vibrate, leading to hearing loss
• Conductive hearing loss: when sound vibrations are not able to reach the inner ear due to a problem with the middle ear bones

Procedure

The stapedectomy procedure typically involves the following steps:

1. The patient is given general anesthesia or local anesthesia with sedation to ensure comfort during the procedure.
2. An incision is made in the ear canal to access the middle ear.
3. The eardrum is lifted and the stapes bone is exposed.
4. The fixed or abnormal portion of the stapes bone is removed, and a prosthetic device is inserted to replace it.
5. The eardrum is replaced and the incision is closed.

Types of Stapedectomy

• Complete stapedectomy: removal of the entire stapes bone and replacement with a prosthetic device
• Partial stapedectomy: removal of only the fixed portion of the stapes bone, with the remaining portion left intact
• Stapedotomy: a smaller hole is made in the fixed stapes bone and a prosthetic device is inserted through it

Risks and Complications

• Infection
• Bleeding or hematoma
• Damage to surrounding structures, such as the facial nerve or inner ear
• Perforation of the eardrum
• Taste disturbance or numbness in the tongue
• Dizziness or vertigo
• Hearing loss or tinnitus (ringing in the ears)

Recovery and Follow-up

After a stapedectomy, patients typically experience:

• A few days of ear pain or discomfort
• A temporary feeling of fullness or pressure in the ear
• A gradual improvement in hearing over several weeks to months

Follow-up appointments with an otolaryngologist (ENT specialist) are necessary to monitor healing and assess the outcome of the procedure.

Success Rates

The success rate for stapedectomy is generally high, with:

• 80-90% of patients experiencing significant improvement in hearing
• 50-70% of patients achieving normal or near-normal hearing levels

Prosthetic Devices Used in Stapedectomy

There are several types of prosthetic devices used in stapedectomy, including:

• Stainless steel or titanium implants
• Plastic or Teflon implants
• Ceramic or glass implants

The choice of prosthetic device depends on the individual patient's needs and the surgeon's preference.