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What does the operation involve?
The commonest operation is called a stapedectomy or more correctly a stapedotomy. This operation has traditionally been carried out under a general anaesthetic however it is quite possible these days to do the surgery under a local anaesthetic and many patients find this a better option. The surgery is done down the ear canal although occasionally a small cut at the top of the ear canal may need to be made.
Using an operating microscope the surgeon lifts up the eardrum. Often a small amount of bone needs to be scraped away to get a clear view. At this stage it is important to confirm the diagnosis and check that it is otosclerosis that is causing the problem. Using delicate instruments and preferably a laser the upper part of the stapes can then be removed. In order to re-establish the chain for transmission of the sound waves a small hole is made in the remaining part of the stapes (the footplate).
A tiny piston is then inserted into the hole and attached to the second bone in the hearing chain (the incus). The vibrations from the eardrum can now be transmitted again to the inner ear. A piece of vein or other tissue can be used to help seal the hole in the footplate to prevent leakage of the inner ear fluids. If the operation is being done under local anaesthetic the surgeon can now fold the eardrum back into place and test the hearing at this stage. At the end of the operation a thin ribbon like pack is placed in the ear canal and left for two weeks.
What happens after surgery?
It is quite common to feel a little dizzy after the operation although with a local anaesthetic this is usually very minor and many patients feel well enough to go home the same day. Dizziness is usually elicited by rapid head movements and so it is advisable to rest and avoid strenuous activity. It is also worth avoiding anything that might increase pressure in the head like straining or heavy lifting. If you need to sneeze try to do so through your mouth to minimise the pressure effect on the ear. It is customary to stay off work for a couple of weeks although this will depend upon the nature of your work. During this time the hearing is likely to be muffled due to the packing in the ear. After two weeks the packing is removed from the ear and an improvement in the hearing is usually apparent however it usually takes several weeks for the hearing to settle completely and there are often fluctuations in hearing over the first few weeks.
How successful is the operation and what are the risks?
In general the operation is very successful with over 90% of people experiencing a good improvement in hearing. Sometimes the hearing remains unchanged and there is a small (approx 1-2%) chance of hearing loss. Hearing results vary from surgeon to surgeon and it is important to ask your own surgeon about his own results and how often he carries out the procedure. As with all operations the best results tend to be achieved by those who do the procedure most frequently. Dizziness, which is experienced by most patients for a short time after the operation, may persist and become troublesome but again this is a rare complication. The nerve that supplies the taste buds at the front of the tongue can be damaged. Usually this is only temporary but occasionally the nerve will have to be cut and a permanent loss results. The nerve that moves the face is located very near to where the surgery is taking place but it is extremely rare for this to be damaged. Sometimes the nerve may be abnormally sited and this may mean that it is not possible to complete the operation. This is not an exhaustive list and it is important to ask your specialist about other possible risks and complications.
All our private ENT specialists at OneWelbeck in London are leaders in their sub-specialties, providing the highest quality treatment to ensure you receive the best available care. Click on the profiles below to see which of our consultants specialise in Stapedectomies.
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