Otosclerosis: Treatment, Procedure, Cost and Side Effects

Stapes removal surgery

Otosclerosis refers to an abnormal growth of the bone situated near the middle ear which can result to hearing loss. This is generally an inherited disorder. The primary form of loss of hearing in Otosclerosis is CHL or conductive hearing loss. In such cases, the sound reaches the ear drum but is not completely transferred via the middle ear, thus failing to reach the inner ear or cochlea. Otosclerosis begins in one ear and affects both the ears later in life. Hearing loss starts with low frequency and then later shifts to high frequency. Most patients who have Otosclerosis notice head noise (tinnitus) to some degree. This usually gets worse when the affected patient is nervous or fatigued.

Many studies suggest that Otosclerosis can be passed down through genes. It can be hereditary in some cases. It usually affects young adults and early symptoms start to occur in mid to early adulthood. Women are more susceptible to it than men. Risk factors include a family history of ear disease, pregnancy, etc. Symptoms of Otosclerosis include vertigo, tinnitus (ringing in the ears) and hearing loss which worsens as time passes. This disease can be cured with the help of a surgery known as stapedectomy. In this procedure, conductive hearing loss can be cured by removing all or just a part of the middle ear bones behind the stapes (eardrum). It is then replaced with a prosthesis as a substitute. This surgery is very effective to help improve the symptoms of otosclerosis.

Stapedectomy is also performed on patients who have stuck or frozen stapes bones. A frozen stapes bone is either caused due to conductive hearing loss or a mechanical ear injury. Stapedectomy is performed under general or local anesthesia. A small incision is made just behind the ear to remove fat or muscle tissue for use in the procedure. With the help of a microscope, the eardrum is turned forward and elevated, the hearing bones have to be palpated and the diagnosis is confirmed only after close observation. The laser is used to vaporize some parts of the stapes and the remaining stapes is removed with the help of an instrument. Then, a small opening is made just in the footplate. A platinum piston, titanium or stainless steel implant is placed into the opening and is then connected to the incus (second hearing bone).

Before the stapedectomy, certain tests are performed for diagnosis and severity of the disease such as audiology/audiometry. A special imaging test can be used which is called a temporal bone CT scan to look for the cause of hearing loss. The stapes prosthesis generally allows vibrations to pass from your eardrum to your inner ear fluids. This corrects the conductive hearing loss and improves the symptoms of Otosclerosis. After the surgery, patients can go home the same day or wait an additional day.

Patients who suffer from otosclerosis, hearing impairment, poor cochlear function, vertigo, tinnitus or conductive deafness are ideal candidates for this surgery.

It is important to seek professional help of a certified doctor before undergoing this procedure. Stapedectomy should only be performed if alternative treatments like medications or using hearing aids fail to make a difference and doesn’t help to improve your hearing impairment.

Stapedectomy is a safe procedure, but it can have certain complications such as tinnitus, granuloma (reparative), labyrinthitis, perilymph fistula, dead labyrinth, tympanic membrane tear, floating foot plate, perilymph gush, vomiting, nausea and facial plasty. Vertigo or dizziness can occur right after the surgery. There are few risks involved in this procedure such as further hearing impairment, tinnitus, mouth dryness, taste disturbance or eardrum perforation. However these risks are rare and depend upon the expertise of the surgeon performing the surgery. According to research, around 5% of patients prefer to go for a repeat surgery because they experience a recurrence of hearing loss in the future.

After the procedure, the patient has to stay in hospital bed to prevent vomiting and nausea. If there is no nausea or dizziness, the patient can be discharged home the same day. Physical strenuous activities or daily activities has to be restricted for the initial week. However, activities like lifting more than 10 pounds, blowing the nose, staining and heavy exercise has to be restricted for 4 to 6 weeks after the surgery. Hearing gradually returns within a month and water should not enter the ear for a period of 2 to 3 weeks. The success rate of the surgery usually depends on the familiarity and skill of the surgeon who is performing stapedectomy. The length and quality of the prosthesis is also a major factor in recovery.

Hearing improvement might or might not be noticeable right after the surgery, but you can gradually see the improvement in a month. If hearing suddenly improves right after the surgery, it can decrease due to swelling in the ear. Maximum hearing can be obtained in six to seven months after the surgery. The amount of hearing improvement largely depends on how well the ear can heal. In most of the patients, the ear heals perfectly, while in some patients only partial hearing can be achieved. In such cases, re-operation is advisable.

The price of stapedectomy surgery in India is approximately Rs. 20,000 to Rs. 81,000.

The results of this surgery is generally positive and reliable in patients whose eardrums have lost mobility due to otosclerosis. Nine out of ten patients who go through this procedure experience excellent hearing within a month. Whereas, less than 1% experience deafness or worsened hearing power. The success of stapedectomy also depends upon the severity of hearing loss a patient has experienced.