One of the most widely performed, hugely successful, and greatly satisfying operations in the field of ENT is the stapedectomy. It is a procedure done to correct deafness due to otosclerosis (a condition caused by the thickening of the stapes: one of the small bones in the middle ear that is important in the conduction of sound). The surgery consists of removing (totally or partially) the stapes, and replacing it with a small prosthesis.
The technique of stapedectomy
The current era of stapedectomy was started by Shea in the 1950s, when he created the first stapes prosthesis from Teflon. Since then various designs of prostheses were created. The procedure is usually performed through the ear canal (trans-canal approach), and can be done either under local or a general anaesthetic.
In an effort to enhance the results of the surgery and to curb the earlier complications, the concept of stapes footplate surgery has slowly changed over the years. The technique most favoured currently is one in which a small hole is made in the fixated footplate for placement of the prosthesis.
The success rate of the operation is now a phenomenal 95% in primary (first time surgery) cases. And with the finicky attention that modern science forces us to pay to detail, even for revision surgery the success rate has soared to 70%.
Effects and complications of stapedectomy
Mild and transient post-operative vertigo is common, and is more significant in those cases where the entire footplate is removed (stapedectomy) than when a small hole (stapedotomy) is made. This is however easily managed by use of oral anti-histamines and steroids.
With the refinement of technique over several decades, long term complications are rare.
- There might be displacement of the prosthesis leading to persistent deafness. This is by far the commonest and easily correctable post-operative complication.
- The dizziness may sometimes persist for long.
- Damage to the (inner ear), though rare, can lead to permanent deafness.
- The tympanic membrane may perforate, and can easily be closed using a facial graft.
- Taste disturbances due to the manipulation of the taste nerve. This is often reversible.
Very often the patient can be discharged the day following surgery. In some clinics this is done on the same day. Stool softeners are useful to prevent straining. An audiogram (hearing test
) is performed about a month following surgery. In the few but inevitable cases where a poor surgical outcome is obtained, revision surgery should be delayed until 3-6 months post-operatively.
Though stapedectomy is not a life-saving operation, it has an immovable place in the vast and exciting field of ENT surgery