Laser stapedotomy

Indications

Otosclerosis is a hereditary ear condition that affects the stapes, the third bone in the middle ear, causing it to become immobile. It can lead to conductive hearing loss and, in some cases, sensorineural hearing loss. Stapedotomy is a surgical procedure that aims to replace the stapes bone with a prosthetic to improve hearing.

Procedure

To perform stapedotomy, an endaural incision is made above the ear canal to gain access to the middle ear. Laser technology is used to remove the top half of the stapes bone, and a teflon piston-type prosthesis is placed in the footplate of the stapes. The prosthesis replaces the stapes bone and restores hearing function.

Possible Risks and Statistics

Stapedotomy has an 85% success rate for significant hearing improvement, 5% of patients experience some hearing improvement, 5% show no improvement, and 5% experience worsened hearing, which can lead to deafness in less than 1% of cases.

Surgical risks include:

• Hearing loss from inner ear injury
  Infection, chemical irritation, etc.
• Dizziness
  It is a common side effect of this procedure and usually mild and lasts for few days. In severe cases, in which inner ear damage occurs, dizziness could last longer, up to several weeks.
• Taste disturbance
  Taste disturbance usually results from the manipulation of the taste nerve in the inner ear space during surgery. However, It is usually temporary and goes away on its own.
• Inner ear fluid leak (a.k.a. “gusher”)
  This happens when the brain fluid leaks via the fenestration by the unnatural connection between the brain cavity and the inner ear. Although it is a rare occurrence, it may need a “lumbar drain” to treat it.
• Facial nerve injury is exceedingly rare

Post-operative notes

After stapedotomy surgery, a patient will usually have 2-3 disolvable sutures on the incision. It is strongly advised to not touch the packing in the ear canal or remove it. To ensure proper healing, try to keep the ear dry at all times until healing is complete. Lifting weights greater than 25 lbs should not be attempted for 4-6 weeks after surgery, and flying should be avoided for the same period. Patients are advised to limit coughing, sneezing, and nose blowing, as the pressure could dislodge the prosthesis and reduce the procedure’s success rate. Most people who perform minimal physical activity can return to work after approximately one week.