Stapedectomy

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Intervention: Stapedectomy
ICD-10 code:
ICD-9 code:	19.1
Other codes:

A stapedectomy is a surgical procedure of the middle ear performed to improve hearing. If the stapes footplate is fixed in position, rather than being normally mobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes. [The world's first stapedectomy is credited to Dr. John J. Shea, Jr., performed in May, 1956. The first patient being a 54 year-old housewife who could no longer hear even with a hearing aid. (http://www.sheaclinic.com/doctors_1.asp).] In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis - a stapedectomy. The results of this surgery are generally most reliable in patients' whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing ability or deafness. Successful surgery usually provides an increase in hearing ability of about 20 dB. That is as much difference as having your hands over both ears, or not. According to a recent study (PMID 16353785), "Good results were obtained in 84.21% of cases...10.52% had no change in air threshold and the rest deteriorated."

When a stapedectomy is done in a middle ear with a congenitally fixed footplate, the results may be excellent but the risk of damage to the hearing is greater than when the stapes bone is removed and replaced for otosclerosis. This is primarily due to the risk of additional anomalies being present in the congenitally abnormal ear. If high pressure within the fluid compartment that lies just below the stapes footplate exists, then a perilymphatic gusher may occur when the stapes is removed. A modified stapes operation, called a stapedotomy, is thought by many otologic surgeons to be safer and more effective in cases of congenital fixed footplate. In stapedotomy, a hole is made in the footplate - often with a laser, and a prosthesis is placed to touch this area with movement of the tympanic membrane.

[edit] External links

• University of Michigan
• Images of surgery
• Illustrations including animation
• Diagrams
• http://www.sheaclinic.com/doctors_1.asp