Stapes Surgery - Stapedectomy

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Video of Stapes Surgery Post-Op Care Surgery Instrument Course & Test Complications

The stapes (small bone in photograph to the right) is one of the three bones in the middle ear. It transmits sound from the incus to the inner ear. In a disease called otosclerosis, it becomes fixed and does not transmit sound as efficiently. A stapedectomy is a procedure which removes a portion of this bone and places a prosthesis to transmit the sound (a House Wire Prosthesis is shown in the photograph to the right). The disease is most commonly found in young women. It is often made worse by pregnancy and the use of birth control pills. Otosclerosis was once very common, but with fluoridation of drinking water the disease has all but disappeared. Click on colored text for word definitions !!
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In performing a stapedectomy, the stapes and all or part of its footplate is removed (light blue) and a prosthesis is placed between the Incus (dark blue) and the inner ear to restore hearing.

The relationship between the stapedial footplate and inner ear structures is very important. The distance between the stapedial footplate and the saccule varies from 1.0 to 1.4 mm and from the footplate to the utricle varies from 0.7 to 1.4 mm. In 25 specimens the shortest distance between the footplate and the saccule was 0.8 mm and between the footplate and the utricle was 0.38 mm.* In patients with Meniere's Disease the endolymph is under high pressure and the membranes of the utricle and saccule are distended. Sometimes they reach the footplate. Stapedectomy in these patients is very hazardous and there is a high risk of postoperative deafness. * Surgical Anatomy of The Temporal Bone and Ear. Anson B.J. and Donaldson, J.A. W.B. Saunders Company p 282, 1973

Stapedectomy Surgical Technique:

Stapes surgery involves removing the top part of the stapes and either removing all or placing a hole in the stapedial footplate. This open the inner ear. A prosthesis is then suspended from the long arm of the incus and placed though the footplate into the inner ear. The attachment of the prosthesis to the incus is one of the hardest parts of the operation. If the prosthesis is attached to loose, it may fall off. If it is attached and the incus sustains too much trauma, the incus may die and the prosthesis will fall off. Below are three new methods to aid in the attachment of the prosthesis to the incus.

Hand Stable Instruments allow for easier and more accurate crimping of the prosthesis to the incus. The "reverse action" of these microsurgical instruments are designed to help stabilize the surgeon's hand during ear and Stapes surgery, reducing tremors and increasing the accuracy of the surgeon.
Learn more about hand stable instruments at www.handstable.com

View Video of Crimping a Prosthesis
with Hand Stable Instruments (1 min 52 secs).

Some prosthesis are made with a clip for attachment to the incus. The prosthesis is first placed on the incus then using a single hand it is gently pushed to engage the clip. Learn more about Kurz Clip-On Prosthesis at www.kurzmed.com

View Video of Stapedectomy Technique
using the Kurz Clip-On Prosthesis

Postoperative Care

For 6 Weeks

No water in operated ear.
No flying for 6 weeks.
No blowing nose, if you sneeze, sneeze with your mouth open.
No heaving lifting or straining.

After the 6 Weeks

No flying if you have a cold or if you cannot clear or pop your ears.

Complications

Complications of stapedectomy include: Numbness on the side of the tongue, dizziness, hearing loss, deafness and a hole in the eardrum. Rarely, facial paralysis and meningitis (a brain infection) can occur.

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