Stapedectomy in India
What is Stapedectomy ?
A stapedectomy is a surgical procedure of the middle ear performed to improve hearing.
If the stapes footplate is fixed in position, rather than being normally mobile, then 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.
Conductive hearing loss (due to fixation of stapes).
Air bone gap of at least 30 dB
Presence of Carhart's notch in the audiogram of a patient with conductive hearing loss (relative).
Good cochlear reserve as assessed by the presence of good speech discrimination.
When 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 (for otosclerosis). This is primarily 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, then a perilymphatic gusher may occur when the stapes is removed. Even without immediate complications during surgery, there is always concern of a perilymph fistula forming postoperatively.
n 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%, and vertigo 0.3%. In this series, there was no incidence of facial nerve paralysis or tinnitus
Vertigo in the immediate post op period
Tympanic membrane tear
Poor general condition of the patient.
Only hearing ear.
Poor cochlear reserve as shown by poor speech discrimination scores.
Patient with tinnitus and
Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
Conductive deafness due to Ehlers-Danlos Syndrome (EDS).
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, and 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, which is now common practice.