Why Do People Get Stapedectomy Surgery?

People primarily undergo a stapedectomy operation to improve their hearing ability affected by otosclerosis. The main reasons for choosing this surgery are as follows:

• Improve hearing: The main goal is to restore the hearing ability or to improve it significantly. The surgery can be a boon for people who wish to regain their normal hearing levels and reduce the severity of their hearing loss.
• Improve quality of life: The surgery helps improve your hearing ability, thereby allowing you to have better communication in work and social environments. You will feel safer and will enjoy sounds and music.
• Non-responsiveness to other treatments: Otosclerosis worsens over time, and hearing aids, the first line of treatment, may not be sufficient for everyone. Stapedectomy surgery can offer a more permanent solution.

The decision to proceed with the operation for otosclerosis is based on the degree of hearing loss, the presence of other medical conditions that may affect surgery or recovery, and the health of the ear. 

Understanding the Anatomy of Human Ear

The human ear has three parts - the outer ear, the middle ear, and the inner ear. Each part has a crucial role to play in your process of hearing by capturing, amplifying, and translating sound waves into electrical signals for the brain to understand.

• The outer ear: The auricle (pinna) is the visible part that captures sound waves from the environment and directs them to the ear canal. The ear canal (external auditory canal) is a tube-like structure that leads sound waves to the eardrum, which is a part of the middle ear.
• The middle ear: The eardrum (tympanic membrane) is a thin membrane that vibrates as sound waves reach it, converting sound energy into mechanical vibrations. These vibrations are now amplified and transmitted to the inner ear by ossicles, the three tiny bones comprising the malleus (hammer), incus (anvil), and stapes (stirrup). There is also an eustachian tube (a canal) that connects the middle ear with the throat (pharynx) and equalizes air pressure on both sides of the eardrum. 
• The inner ear: There is a snail-shaped cochlea, the fluid-filled organ that transforms mechanical vibrations into electrical signals through tiny hair cells for the auditory nerve to send to the brain. There are also semicircular canals (labyrinthine) that tell the brain which direction your head is moving and maintain balance.
• Additional components: The auditory or vestibulocochlear nerve transfers electrical signals from the cochlea to the brain to allow perception of sound.  Then there are round and oval windows, membranes that separate the middle and inner ears, and help in the transmission of vibrations to the cochlea.

The anatomy of the ear is such that it efficiently captures sound waves, converts them into mechanical and electrical signals, and transfers them to the brain for interpretation. This allows us to hear and understand sounds around us and also maintain balance and spatial orientation.

Different Types Of Stapedectomy Surgery

The following table outlines various types of stapedectomy, which are all designed with variations to optimize outcomes:

Each type of stapedectomy surgery carries its own set of benefits, risks, and suitability criteria for different individuals, based on individual health, surgeon’s expertise, and technological availability. The decision to proceed with a particular technique is about restoring maximum hearing ability and minimizing risks.

Stapedectomy Surgery - What You Can Expect

Here are the details of what happens before, during, and after a stapedectomy surgery:

Before Surgery (Preparation)

A thorough preparation is required for stapedectomy:

• Medical evaluation: The doctor will discuss your medical history and perform a physical examination. Some audiometric tests might be conducted to assess the level and type of hearing loss. Imaging studies like CT scans may also be recommended to get a detailed view of the inside of the ear. 
• Consultation: The surgeon discusses the potential risks and benefits of the surgery, the surgical plan, and what can be expected postoperation. 
• Medication review: The doctor will review any current medications or supplements. Some medications such as blood thinners will have to be discontinued for a brief period to lower the risk of bleeding.
• Diet and lifestyle changes: Patients will receive instructions on diet to be followed before the procedure. The surgeon will recommend quitting smoking and reducing alcohol consumption to lower the risk of complications.
• Arrange help: Arrange someone to drop you back from the hospital or healthcare facility. Also, arrange for someone to assist you at home during your recovery.

A careful preparation plan can allow for a smoother procedure and comfortable recovery. Make sure you discuss all your concerns with your healthcare provider beforehand. 

During Surgery (Stapedectomy Steps)

Here’s an overview of how the stapedectomy procedure is typically carried out:

Anesthesia: Local or general anesthesia is administered to the patient based on his/her preference, health status, and the recommendation of the surgeon.

• Making incision for accessing the middle ear: Now, the surgeon makes an incision in the ear canal or behind the ear to access the middle ear. Then s/he lifts a small section of the ear canal skin and eardrum to see the middle ear bones (ossicles).
• Examination and removal: Otosclerosis is confirmed and the stapes bone is partially or entirely removed. If it’s a stapedotomy, a small part of the stapes footplate is removed, or a small hole is made in it.
• Placing the prosthesis: Now, the prosthesis is prepared and placed to bypass the fixed stapes bone so that it fits snugly into the opening to the inner ear, the oval window. The other end of the prosthesis is attached to the incus or anvil (another bone in the middle ear).
• Sealing the oval window: Where the prosthesis enters the oval window, a small piece of tissue is taken from the patient’s vein or fat to seal around the prosthesis and prevent the leakage of the inner ear fluid (perilymph).
• Reconstruction and closure: Finally, the eardrum and the skin in the ear canal are placed back carefully, followed by a closure of the incision with stitches. The incision may also be allowed to heal on its own. 

Now, the patient is taken to the recovery area/room, and his/her vitals are monitored. Antibiotics and pain medications may be prescribed to prevent infection and manage discomfort.

After Surgery (Recovery and Outlook)

The recovery after stapedectomy and the longer-term outlook is as follows:

• Immediate postoperative period: You may experience pain, discomfort, and a feeling of fullness in the operated ear. This can be managed with prescribed medications. There may be dizziness or balance problems, which will improve within a few days.
• Short-term recovery: Strenuous activities, such as blowing the nose, and swimming should be avoided. Showering, hair washing, etc should be done carefully, and the ear should be kept dry to prevent infection. 
• Long-term recovery: Once fully recovered, you may need periodic check-ups with your otolaryngologist to monitor your hearing and overall ear health.

For best results, patients should openly communicate with the doctor, follow all postoperative appointments, and care for the operated ear. With proper monitoring, the stapedectomy surgery can offer a promising solution to hearing loss due to otosclerosis.   

Stapedectomy Surgery - Risks / Benefits

As with any surgery, stapedectomy comes with certain risks and benefits. 

Risks: 

• Further hearing loss
• Persist vertigo and balance issues in some cases
• Worsened ringing in the ears
• Loss of taste or taste disturbances
• Leakage of perilymph (inner ear fluid), leading to hearing loss, dizziness, and balance issues
• Dislodging, migration, or extrusion of the prosthesis, requiring a revision surgery

Benefits:

• Improved hearing, which can be life-long
• Better communication and improved quality of life
• Permanent solution when compared to treatment options like hearing aids
• High success rate
• No need for additional devices or treatments later on

The decision to undergo a stapedectomy or otosclerosis surgery should be taken after a thorough consultation with an ENT surgeon. Considering all risks and benefits beforehand will help you make informed decisions.