Definition and Overview
Also known as laser stapes surgery, stapedectomy is the surgical removal of one of the three tiny bones of the middle ear called stapes or stirrup using a drill or laser. This is typically followed by the implantation of a microprosthesis to treat conditions like otosclerosis or conductive hearing loss, which cannot be treated with medication. Thus, surgery is the first and the only effective treatment for the condition.
The procedure is often compared with stapedotomy, which involves the opening of the footplate or base of the stapes to place a titanium implant.
Who Should Undergo and Expected Results
Stapedectomy is the surgical treatment of otosclerosis, a medical condition characterised by the “overgrowth” of the stapes, which can result in conductive hearing loss since the affected bone becomes immovable and sometimes attached itself to the other nearby bones. This results in poor transmission of sound waves from the middle to the inner ear, particularly the cochlea, which is responsible for converting the sound into electrical impulses that can be understood by the brain. In certain cases, otosclerosis directly affects the cochlea, which disturbs balance and causes ringing in the ears called tinnitus.
Although there’s no definite cause for otosclerosis, many experts believe that it can be triggered by certain illnesses like measles or an infection, or inherited due to a faulty gene.
The condition usually develops slowly, taking months or years before the symptoms, which may begin with the inability to hear faint sounds or whispers, become more prominent.
Stapedectomy can significantly improve a person’s hearing function. However, studies show that at least 2% of those that are affected with the condition may continue to experience progressive hearing loss. If the hearing loss is already severe, the person may be fitted with a hearing aid or a cochlear implant.
How Does the Procedure Work?
In stapedectomy, the patient is provided with local or general anaesthesia while the bones are accessed through the ear canal. The eardrum is folded forward to see the bones and a microscope is used to confirm otosclerosis.
If the condition is confirmed, the surgeon proceeds by detaching the stapes from the rest of the ossicles by either directing a laser beam to the bone or using a drill. Depending on the extent of the condition, the surgeon may elect to remove only a part of the diseased bone or take away all of it using surgical tools. The laser beam is utilized again to create a hole in the wall that separates the middle and inner ear, in which the bones rest. Prosthesis is then placed into the hole and is connected to the incus bone. The surgeon tests the function of the bones and the prosthesis before the area is sealed using a graft material like the skin tissue from the incised earlobe. The eardrum is returned to its original position and the canal is closed with a special sponge.
The entire procedure can be performed on an outpatient basis and usually takes about an hour to complete. Recovery may take a few days.
Possible Risks and Complications
It’s possible that even with laser stapes surgery, the patient will continue to lose his ability to hear. It may also cause vertigo if the inner ear is severely disturbed or the disease progresses to cochlear otosclerosis. Eardrum perforation can also occur as well as partial paralysis of the facial nerves. Both stapedectomy and stapedotomy can increase the risk of bleeding and infection, but stapedotomy is considered much safer since it doesn’t completely change the structure of the middle ear.
House JW, Cunningham CD III. Otosclerosis. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 144.
O'Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 19.