Menu Close

Stapedectomy

STAPEDECTOMY FOR OTOSCLEROSIS

Selection of patient for stapes surgery:

  1. Patients with social hearing handicap (air conduction threshold ≥ 30 dB)
  2. Air-bone gap of at least 15 dB
  3. Rinne negative test results at 256 and 512 Hz
  4. Speech discrimination score ≥ 60%

Steps of Stapedectomy: The surgery is preferably done under local anaesthesia

  1. Flap Elevation: An incision is made in the ear canal, and the tympanomeatal flap is elevated.
  2. Exposure and Disconnection: The surgeon exposes the stapes, separates it from the incus, and cuts the stapedius tendon.
  3. Stapes Removal: The superstructure of the stapes is fractured and removed carefully, away from the facial nerve. However, it is better to first divide the posterior crus with laser/ crurotomy scissors to reduce the risk of mobilizing the footplate.
  4. Measurement: The distance between the incus and footplate is measured. The prosthesis selected to be 0.25 mm longer than the distance from the underside of the incus to the footplate.
  5. Fenestration: A small hole (fenestration) is made in the posterior third of the footplate (stapedotomy) or the removal of a part of the footplate (stapedectomy) using a laser or drill.
  6. Prosthesis Placement: A prosthesis, slightly longer than the measured distance, is inserted and secured.
  7. Flap Repositioning: The tympanomeatal flap is repositioned, and the surgery is complete.

Diagram: Steps of a Stapedotomy in a Right Ear

  • Image 1: Elevation of Tympanomeatal Flap and Curetting of Scutum
    The procedure begins with the elevation of the tympanomeatal flap. This is followed by curetting the scutum to ensure adequate exposure. The exposure is considered sufficient when the facial nerve, pyramidal process, and round window are clearly visualized.
  • Image 2: Measurement and Preparation
    Next, the surgeon takes precise measurements from the medial aspect of the incus to the footplate. This is followed by the separation of the incudo-stapedial joint and the sectioning of the stapedial tendon.
  • Image 3 and 4: Drilling and Down-Fracturing
    The surgeon then drills the posterior crura of the stapes, making the footplate visible. Following this, the remaining stapes superstructure is carefully down-fractured. During this step, it is crucial for the surgeon to monitor the footplate closely to prevent dislocation.
  • Image 5: Fenestration of the Footplate
    Once the superstructure is removed, a fenestration (small opening) is created in the footplate.
  • Image 6: Insertion and Crimping of the Piston
    Finally, a piston is inserted into the fenestration. The procedure concludes with crimping the piston to the incus, ensuring proper placement and function.

Contraindications of stapes surgery:

  1. Otosclerosis in the only hearing ear.
  2. Age > 70 years.
  3. Young children- Recurrent eustachian tube dysfunction may displace the prosthesis or cause acute otitis media.
  4. Sportspersons, snorkelling, parachuting, construction workers at high altitudes, scuba divers and frequent air travellers have a risk of postoperative vertigo.
  5. Patients having occupational noise exposure are susceptible to sensorineural hearing loss after surgery. 
  6. Pregnancy

 Relative contraindications:

  1. Diabetes, active otosclerosis and eustachian tube dysfunction.
  2. Active infection in the outer or middle ear, tympanic membrane perforation and exostosis 

Complications of stapes surgery:

  1. Conductive Hearing Loss: This can result from prosthesis displacement, incus erosion, or new bone growth.
  2. Sensorineural Hearing Loss (SNHL): This may occur due to surgical trauma, barotrauma, or inflammation (labyrinthitis).
  3. Facial Nerve Injury: Caused by overheating from the drill or incorrect local anaesthesia.
  4. Vertigo: Often temporary and resolves within a week.
  5. Incus Dislocation: This can happen during surgery or later due to pressure changes or infections.
  6. Taste Disturbances and Dry Mouth: Due to injury to the chorda tympani nerve.
  7. Dead Ear: In rare cases, permanent total hearing loss may occur, often due to reparative granuloma after surgery.

———— End of the chapter ————

Download the full PDF Link:

Stapedectomy for Otosclerosis Best Lecture Notes Dr Rahul Bagla ENT Textbook

Reference Textbooks.

  • Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
  • Glasscock-Shambaugh, Textbook of Surgery of the Ear.
  • P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
  • Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
  • Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery
  • Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
  • Salah Mansour, Middle Ear Diseases – Advances in Diagnosis and Management.
  • Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
  • Rob and smith, Textbook of Operative surgery.
  • Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
  • Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.
  • Gordon B. Hughes, Myles L. Pensak, H. B. Broidy. Textbook of Clinical Otology.
  • Mario Sanna. Textbook of Color Atlas of Endo-Otoscopy Examination–Diagnosis–Treatment.

Author:

Dr. Rahul Bagla ENT Textbook

Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India

———– Follow us on social media ————

Keywords: Carhart’s notch, Flamingo, schwartz sign in otosclerosis, otosclerosis ppt, pathophysiology, radiology, cochlear otosclerosis, stapedial otosclerosis, Otosclerosis natural treatment options, Early signs of otosclerosis, Otosclerosis and tinnitus management, Otosclerosis hearing aids effectiveness, Stapedectomy success rates in otosclerosis patients, Exploring Natural Treatment Options for Otosclerosis, Recognizing the Early Signs of Otosclerosis: A Comprehensive Guide, Managing Tinnitus in Otosclerosis Patients: Effective Strategies, Evaluating the Effectiveness of Hearing Aids for Otosclerosis, Understanding Stapedectomy Success Rates in Otosclerosis Treatment

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *