Stapes surgery for otosclerosis
Otosclerosis is one of the leading causes of progressive hearing loss in young people. In this article, consultant ENT surgeon Mr Joseph Manjaly details how stapes surgery can treat otosclerosis.
What is otosclerosis?
Otosclerosis is when a bone in the middle ear, the stapes bone, stiffens due to abnormal bone remodelling. The role of the stapes bone is to conduct sound vibrations from the outer ear to the inner ear. When this bone becomes dysfunctional, hearing ability gradually deteriorates. Hearing loss as a result of otosclerosis can range from mild to severe, but it is rarely total. It may occur in both ears, but it is also common for one ear to be more affected than the other.
Research remains ongoing looking at why otosclerosis happens, but it most commonly occurs in patients between the ages of 25 and 50, and more often in female patients.
What are the symptoms of otosclerosis?
In the earliest stages of otosclerosis, the hearing loss is so subtle that the patient may not immediately notice, instead subconsciously compensating for the condition with increased listening effort or turning up the volume of their devices. Progression may take course over several years, decades even. Patients may begin to retreat from social environments and professional opportunities, and feel drained by the effort it takes them to listen adequately to conversation, audio, and music.
How is otosclerosis diagnosed?
To get diagnosed with otosclerosis, doctors conduct hearing tests on the patient, such as a masked audiogram, which tests the audible range of frequencies of the patient via natural and bone conduction routes, and a tympanogram, which analyses the condition of the eardrum. To visualise the structure of the inner ear’s bones and tissues, a CT scan may also be conducted.
How is otosclerosis treated?
There are several options available for treating otosclerosis. These include conservative measures, hearing aids, bone conduction devices and implants, and stapes surgery, sometimes known as stapedotomy or stapedectomy. Patients with otosclerosis should consider all the possibilities to decide the best course of action for themselves.
One of the main treatments for otosclerosis, stapedotomy (also known as stapedectomy), is a microsurgical procedure to replace the stapes bone with a tiny prosthesis that performs the same function as the original bone before dysfunction, enabled by making a 0.6mm hole into the inner ear.
A surgery that has been used since the 1950s, it is a highly successful procedure, with majority of patients reporting that their hearing improves significantly afterwards and they can reengage with the audible world again.
Stapedotomy may be more preferable than bone conduction implants and hearing aids as the sound is more authentic and closest to natural, functional hearing ability.
Are there any risks to stapes surgery?
However, stapedotomy is a complex procedure, due to the intricacies of the anatomy and the very small working area for the surgeon. The procedure necessitates the use of a laser or microdrill to puncture the inner ear, very close to the facial nerve, to make a 0.6mm hole. If even a one-tenth of a millimetre miscalculated, there could be significant trauma and even complete and total hearing loss – permanently.
Other risks and complications, which are less severe and may be temporary or infrequently occurring, include dizziness, tinnitus, weakness of the facial muscles, and infection.
This article has more detailed information for patients with otosclerosis who are considering their options.
If you would like to know more about stapes surgery and other forms of otosclerosis treatment, consult with Mr Manjaly on Top Doctors.