Otosclerosis Complex Stapedectomy

Risk Factors

Risk factors for otosclerosis:

• Family history of otosclerosis
• Female gender with hormonal fluctuations
• Pregnancy worsening existing disease
• Caucasian or Asian ethnicity
• Vitamin D and fluoride deficiency

Who is at Risk

Adults aged 15 to 45 years with progressive hearing loss, particularly women and those with a family history of otosclerosis, are most commonly affected. Bilateral disease occurs in approximately 70 percent of cases.

Diagnosis

Diagnosis includes:

• Pure tone audiometry showing conductive or mixed hearing loss
• Tympanometry showing stiffened tympanic membrane pattern
• CT scan of temporal bones for confirmation
• Carhart notch on audiogram (dip at 2000 Hz)
• Tuning fork tests showing Rinne negative and Weber lateralizing

Treatment Options

Treatment options include stapedectomy or stapedotomy with titanium or Teflon piston prosthesis, hearing aid as an alternative, and sodium fluoride therapy to slow disease progression. Surgery offers the best hearing outcomes in eligible candidates.

The Procedure

Complex stapedectomy involves:

• Local or general anesthesia with transcanal or endaural approach
• Elevation of the tympanomeatal flap
• Removal of the stapes superstructure
• Laser fenestration or complete removal of the stapes footplate
• Placement of titanium or Teflon piston prosthesis
• Fat or tissue seal around the piston at the footplate
• Tympanomeatal flap repositioning and pack placement

After the Surgery

Post-operative care includes:

• Avoidance of nose blowing for 2 weeks
• No flying for 4 to 6 weeks post-operatively
• Antibiotic ear drops and pain management
• Audiological test at 6 to 8 weeks to assess hearing improvement
• Avoidance of loud noise exposure
• Light activity restrictions for 1 to 2 weeks

Possible Complications of Stapedectomy

Potential complications include:

• Total sensorineural hearing loss (dead ear) in rare cases
• Dizziness and vertigo post-operatively
• Perilymph fistula causing fluctuating hearing
• Tinnitus or altered hearing perception
• Displaced or extruded piston prosthesis
• Taste disturbance from chorda tympani nerve handling