Stapedectomy

Stapes is the smallest bone of the ear and its function is to send the sound vibrations to the ground level flat bone. Osteosclerosis in stapedectomy comes in between the stapes and forms the new bone, due to this diversion: stapes fail to send the sound to the flat base bone and ultimately cause hearing loss. During the procedure stapes or stirrup bone is substituted with a new bone. Stapedectomy surgery hardly takes 1.5 hours. In some people hearing loss arises in both the ears so for such people more affected ears are taken under the procedure first. 

Only one method is found till date to perform stapedectomy and that is via the ear canal. No major pain occurs during the surgery. Stapedectomy after surgery results are outstanding as above 90% of people get a good recovery and long-lasting effects.

 

Stapedectomy Surgery Procedure

Let’s take a closer look at before, during and after stapedectomy.

BEFORE :

• Make sure you are consulting a licensed doctor. Before having a procedure you will need to have a consultation with your surgeon, during this time following things will happen.
• Surgeons will suggest you bring a companion to pick and drop you on the day of surgery. 
• Advice will be given on quitting smoking and narcotic drugs as both come as a hurdle in every surgery so avoiding a few weeks before the surgery is very advantageous.
• The doctor will click photos and take the measurements of the ear.
• The doctor will do a blood and x-ray test prior to the surgery.
• Some sips of tea and coffee is fine but do not eat 6-7 hours before the surgery.
• Stop taking anti-inflammatory medicines.
• A room will be given to you a day before the surgery if you are travelling from a long distance.
• The discussion will also happen regarding postoperative care, risks, complications and potential cost.

DURING THE PROCEDURE:

• Stapedectomy is totally an outpatient procedure; it can take 60-90 mins depending upon the complexity and specifics of the procedure.
• Local anesthesia is used for people above 18 years and for children general anesthesia is used maximum times. Anesthesia helps to relax and doesn’t let a patient feel the pain.
• A powerful and accurate operating microscope will be placed, after a precise observation in the ear doctor will steadily make a tiny incision ear canal which is not far from the ear drum, then ear drum will be taken up to keep an eye on the middle ear. 
• Surgeon will scan all the 3 bones of the middle ear, malleus, incus and stapes to confirm the injury of stapes. 
• Harmed portions of staples are removed by hands, without using any automatic instrument.
• BY keeping the base flat plate stable, either the whole or a particular part of stapes is removed, with the use of a laser or drill.
• Stapedectomy prosthesis is also available when a flat base plate is injured, best alternatives are steel, platinum, nitinol, wire loop and titanium, one of these is attached to the incus.
• The alternative method is Holt’s method and is used in severe cases, the entire stapes bone is taken out through steel.

AFTER THE SURGERY :

• Once all set and done, a little unconsciousness will be seen in your body because of anesthesia but won’t last for more time.
• You will be transferred to the general unit and there your oxygen level, then your pulse rate through radial method will be checked and other vitals such as blood pressure, haemoglobin all will be observed.
• Spending upon the complexity of surgery, the doctor will decide your stay at hospital.
• You will leave with a prescription, diet plan and essential list of do’s and don’ts.

STAPEDECTOMY RECOVERY PERIOD

• Hearing will start after a few days of the surgery and will gradually increase so don’t get disappointed or impatient.
• After 5-6 days you have to pay a visit at hospital and there your dressing will be done and packing will be taken out. Pain, swelling and dizziness will happen but no need to worry.
• You will notice exact hearing after a month.
• Resume or regular work but avoid going to work for 2 months if your job is around machinery, noisy areas and do not put earphones or headphones.

STAPEDECTOMY RISK FACTORS

Anyone can develop below mentioned risk factors, but clearly visible in some and not in others.

• Bleeding
• Infection
• Hole can be seen in eardrum
• Tinnitus – It is common, it gives ringing and noisy feeling in the ear, about 20% people go through tinnitus after stapedectomy.
• Facial nerve becomes immobile
• Perforation
• Vertigo

COMPLICATIONS

Serious complications which can damage ear are :

 

• Tympanic membrane gets proliferated
• Damage in cochlea
• Wheezing
• Weird food taste
• Anesthesia complications

Stapedectomy Post Operative Experience

 

Stapedectomy offers good long term results and the majority of the people don’t get any kind of hearing problems as the success rate is above 90%. While 10% may need further surgery to achieve good hearing capacity. By avoiding swimming, scuba diving, heavy sounded disco clubs, etc. increase the chances of hearing.

Stapedectomy Cpt Code 

69660 is the CPT code for both manual stapedectomy and advanced laser stapedectomy.

What’s The Cost Of Stapedectomy?

Stapedectomy is covered by health insurance or government insurance while hearing aid is not.  But though insurance is covered additional expenses will be there.

Cost depends on where you live, where the doctor’s clinic is present, your overall health and other factors. In India the cost of stapedectomy is between 30,000 rupees to 80,000 rupees which means $400-$800 US dollar. In the UK the cost of stapedectomy is around 3000 pounds which means approximately 3500 US dollars.

In Australia the cost of stapedectomy is around 4000 australian dollars which means 2800 US dollars. 

In the US the cost of stapedectomy is around 3200.

Stapedectomy Surgeons

Finding a right surgeon with a history of successful surgeries is a little daunting task but I have made a solution to help you all by making a list of successful ENT specialists in India, UK, US and Australia.

Symptoms

• Dizziness and nausea

• Temporary taste change

• High-frequency loss of hearing

• Lack of or no hearing improvement

• Complete loss of hearing

• Facial nerve paralysis

• Tear in eardrum

Causes

POST STAPEDECTOMY SYMPTOMS

At first you may not notice any sort of changes in the hearing, after surgery. Seek emergency help if you see any of the following symptoms

• Incus necrosis
• No changes in hearing 
• Middle ear and external year injury and infections
• Perilymph gusher
• Desguesia

 

What Are The Side Effects Of Stapedectomy?

• Nausea
• Quick breathing
• Sensitive to noisy areas with machines
• Ringing the ear

FAQ

• Stapedectomy Vs Stapedotomy

STAPEDOTOMY – A part of stapes removal through laser or drill is known as stapedotomy

STAPADECTOMY – Entire stapes bone’s removal is known as stapedectomy.

STAPEDOTOMY – It is less traumatic

STAPEDECTOMY – It is more traumatic

STAPEDOTOMY – It comes with less post operative complications

STAPEDECTOMY – Comes with more post operative complications

STAPEDOTOMY – The use of tissue graft seal of the fenestra can be done.

STAPEDECTOMY – Tissue graft seal of the fenestra cannot be used.

• What Is Bilateral Stapedectomy?

When a stapes bone doesn’t move at all, becomes stubborn and stays in one place for more time, the use of bilateral stapedectomy is done to continue its movement.

• What Is Endoscopic Stapedectomy?

When the use of an endoscope is done to thoroughly see the oval ear window, to measure the complications this is very competitive and surgeons’ sometimes prefer this over the normal microscope.

• What Is The Revision Stapedectomy’s  Success Rate?

It is around 75-80% and with the popularity of laser, it is growing tremendously.

• Can Stapedectomy Be Repeated?

Yes, it can be repeated but success rate decreases by 5-10%.

• Are Mri Stapes Implants Safe In Stapedectomy?

 

Yes, if the prosthesis is done by using titanium then it is safe.