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is performed to surgically remove the
after it has
become fixed by a bone disease called
otosclerosis. The operation
to the outside. It is very important to maintain
sterility. The fluids of the inner ear are the same as the cerebral
spinal fluid. Since this course is on instruments we will present a
using ear instruments. Many surgeons are now
using micro-lasers and micro drills for removal of the
is approached through the ear canal. An ear canal flap is
raised using a similar technique to that used in a
is entered. The bone of the
superior canal is
removed and care is taken not to injure the
disturbance or some tongue numbness may result. The
have to be sacrificed during the operation if it is obstructing the
procedure and cannot be retracted.
measuring rod is now used to measure the distance between the
the undersurface of the
incus. The usual distance is 4.5 mm.
next step is to use a pick to test the fixation of the
stapes. If it
is found to be fixed a thin sharp gently curved pick is used to perforate
stapedial footplate. This will relieve pressure on the
becomes mobile during the operation.
is now disarticulated from the
using a joint knife or a
Tabb Knife. A long 90 degree pick can also be used for this purpose.
the stapedial tendon is cut using a pair of micro-scissors or Bellucci
superstructure is removed using a large pick.
First slowly move the superstructure upward then quickly downward.
hole in the
is widen using a short 45 degree pick then a short 90
degree pick, followed by a longer 90 pick. A
prosthesis is then placed
and the oval window sealed with blood or tissue.
hole can also be enlarged using a mushroom pick. This pick
has a mushroom shaped end and thus can remove bone in any direction.
of blood from around the
must be done with great care. It is
very easy to damage the inner ear with may result in deafness and dizziness.
A #24 or #26 suction is used and the surgeon's finger is not placed over the
suction hole. He should suction around the footplate opening and not
over it. (Note: Two different systems are used to describe
the sizes of suctions. The small numbers, French System, apply to the
three Baron Suctions, the larger numbers are used for the stapes needle
suctions. In the French system, the size of the tube increases
as the numbers get larger. With the needle suctions, the size of the
tube gets smaller as the numbers increase. In these two numbering
systems, a #20 stapes needle suction is approximately the same size as a #3
French Baron Suction. )
is grasped with a smooth alligator forceps. A serrated forceps may
prosthesis or bend a house wire wire
The picture to the right shows a house wire
prosthesis positioned between a
and a dime.
in the pictures to the right are smooth (far right picture ) and serrated
(near right picture) alligator forceps.
a wire loop is used as a
prosthesis, one of a variety of different crimpers are used
to secure the
prosthesis to the long arm of the
Shown in these pictures are several McGee Stapes Crimpers.
picture to the right shows a reverse action McGee crimper. Note the
grove in the crimper's head for the stapes wire.
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Kavanagh, All Rights Reserved
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