PLASTIC SURGERY: Silicon sheet & Block, External Nasal Splint, Silicon Ear Plug, Tampon Roll Type Prosthesis, ATELOCOLLAGEN Implant, Eyeball Restraint Insert, Skin Marker, Contact Shell etcICU PRODUCTS: Ventilation Circuit, HME filter, Nebulizing Mask, Oxy.
While reports of stapes surgery dates back to at least 1876, the era of modern stapes surgery began after 1957, when John Shea, MD, replaced the stapes with a prosthetic artificial stapes. In the 1960s and 1970’s stapes surgery reached its heyday, with experienced surgeons doing incredibly high volumes of this operation due to the backup volume of un-operated cases. Leading surgeons such as Harold F. Schuknecht, MD, at Massachusetts Eye and Ear Infirmary, Harvard Medical School, performed over 20,000 stapedectomies. Professor Schuknecht taught Dr. Hammerschlag this operation, which he has been performing since his residency. Dr. Hammerschlag is a member of the Otosclerosis Study Group, consisting of 130 members, who are the leading ear surgeons performing this operation. The Otosclerosis Study Group meets each year to review the scientific and therapeutic advances in treatment of otosclerosis. Dr. Hammerschlag performs and teaches this operation to otolaryngology residents and fellows at New York University Langone Medical Center.
After about ten days, the packing is removed and a good evaluation can then be obtained as to whether the graft was successful. Water is kept away from the ear and blowing of the nose is discouraged. If there are allegies or a cold, further antibiotics and decongestant should be given. Most individuals can return to work after five or six days unless they perform heavy physical labor, in which case the patient can return after two or three weeks.
After three weeks, all packing is completely removed under the operating microscope in the office. It can then be determined whether the graft has fully taken. In over 90 percent of cases, the tympanoplasty procedure is successful and a hearing test is performed at four to six weeks after the operation.
Failure of tympanoplasty can occur either from an immediate infection during the healing period, from water getting into the ear, or from displacement of the graft after surgery. Most patients can expect a full "take" of the grafted eardrum and improvement in hearing. After three to four months, water can be allowed to enter the ear and the patient can even return to swimming.
While the hearing tests are very helpful, otosclerosis is definitively diagnosed at the time of surgical examination of the middle ear. If otosclerosis is confirmed at this time, the surgeon can repair the conductive hearing loss.
If opened from behind, the ear is then stitched together. Usually, the stitches are buried in the skin and do not have to be removed later. A sterile patch is placed on the outside of the ear canal and the patient returns to the recovery room. Generally, the patient can return home within two to three hours. Antibiotics are given along with a mild pain reliever such as Tylenol or Tylenol with Codeine.
Conductive hearing loss is treated with amplification with a hearing aid or surgery. Amplification with a hearing aid is very successful because the inner ear (nerve) function is usually normal. Sometimes the abnormal bone metabolism may also affect the sensorineural (nerve) function in the cochlear, which can reduce hearing.
If ossicular reconstruction is necessary in the tympanoplasty, then an overnight stay is often recommended. There can be imbalance and dizziness immediately after this procedure. Dizziness is uncommon in operations that only involve the eardrum itself. Besides failure of the graft, there may be further hearing loss due to unexplained factors during the healing process. This occurs in less than five percent of individuals undergoing the operation.. A total hearing loss from tympanoplasty surgery is rare. This occurs in less than one percent of operations. Postoperative dizziness and imbalance can be present for about a week after surgery and are usually very mild. If the ear becomes infected postoperatively, the risk of dizziness increases. Generally, all imbalance and dizziness will be resolved after a week or two.
The hearing test gives the best preliminary information to suggest this cause of conductive hearing loss. Frequently, the audiogram has certain features typical for otosclerosis. A tympanogram, which measures the movement of the eardrum under specific test conditions, can show a waveform observed with otosclerosis. A CT scan of the middle and inner ear may demonstrate bony changes seen with otosclerosis. CT scan studies are not routinely ordered for the diagnosis of otosclerosis. If your history and office examination indicate that there may be other causes of your conductive hearing loss, then a CT scan may be utilized.
Tinnitus or noises in the ear, particularly an echo-type feeling, may be present as a result of the perforation itself. Usually, with improvement in hearing and closure of the eardrum, these sensations clear up. However, tinnitus is unpredictable. In some cases, it can temporarily worsen after the operation. There is no explanation for this temporary situation, but it is rare for the tinnitus to be permanently worse after surgery.
Frequently patients do not want to resort to hearing aids when successful surgery, called stapedectomy (removal of stapes or part of it) or stapedotomy (a term referring to small hole in stapes footplate), can improve hearing in otosclerosis. This microsurgical operation replaces the immobile stapes bone with a mobile prosthesis – usually made of stainless steel/platinum and/or Teflon, which is not rejected by the body. In properly selected cases, the hearing improvement can reach complete or near complete elimination of the conductive hearing loss in 96% of the operative cases in the hands of experienced ear (otologist) surgeons. Three percent may have no change and up to 1% may have loss of hearing, which would not be helped with a hearing aid. Dizziness may occur following stapedectomy; it is usually transient, just for a few days. Tinnitus is reduced or eliminated in about 50% of the patients who had this symptom before surgery.