Otosclerosis is a medical condition that affects the middle ear bones, particularly the stapes, which is one of the three tiny bones responsible for conducting sound waves to the inner ear.
In otosclerosis, abnormal bone growth occurs, leading to the fixation of the third middle ear bone (stapes bone), which restricts its ability to move. This fixation impairs sound transmission, resulting in conductive hearing loss.
An otosclerosis surgeon specialises in diagnosing and treating otosclerosis and is often known as a stapedectomy surgeon.
The most common symptom is gradual loss of hearing, which may initially affect one ear and later progress to both.
In rare cases, they may experience sudden fluctuations in hearing, which can be distressing. Sensorineural hearing loss is less common with otosclerosis, but may still occur. It is caused by damage to the inner ear (cochlea) or the auditory nerve pathways to the brain.
Otosclerosis patients may experience tinnitus (ringing or buzzing in the ears) or a sensation of fullness in the ear. Although less common, some people may experience balance issues or dizziness, particularly if the otosclerosis affects the inner ear structures.
This is a phenomenon where there is a rapid increase in perceived loudness in response to loud sounds, making certain noises uncomfortable or painful.
If hearing loss progresses to a more severe stage, surgical options for otosclerosis treatment, such as stapedectomy, may be considered to restore hearing more effectively. This approach ensures that patients receive the most appropriate and least invasive treatment for their condition before considering surgical interventions.
Hearing aids are generally the first-line treatment for mild to moderate cases of otosclerosis. It would be unusual to proceed to surgical treatment without first trying a hearing aid, as they can significantly enhance hearing ability and improve quality of life for those affected. These devices amplify sound, making it easier for individuals to communicate and engage in daily activities.
Some symptoms of otosclerosis are similar to other conditions, such as cholesteatoma, myringoplasty or the need for cochlear implants or grommets. It is always essential to seek the advice and diagnosis of a professional ENT surgeon.
It is important for individuals experiencing hearing difficulties to undergo thorough evaluations by an ear specialist. They may ask how long you have experienced hearing loss, if you have symptoms of tinnitus or vertigo, and if you have a family history of otosclerosis. Diagnostic tests, including audiometric evaluations and imaging studies, can help differentiate between stapedial and cochlear otosclerosis.
Understanding the specific type of otosclerosis is crucial for determining the most appropriate treatment plan and managing expectations regarding hearing outcomes. Early diagnosis and intervention are essential in preserving hearing and enhancing quality of life for those affected by this condition.
Cochlear otosclerosis occurs when the bony overgrowth extends beyond the middle ear, infiltrating the inner ear and affecting the cochlea’s structures. This form of otosclerosis is more serious, as it can lead to permanent and non-reversible sensorineural hearing loss once it develops. In cases where hearing loss has progressed significantly or when other treatments like stapedotomy or hearing aids are insufficient, patients may benefit from cochlear implant surgery.
Stapedial (Fenestral) otosclerosis involves a bony overgrowth specifically affecting the stapes bone in the middle ear. This overgrowth leads to the fixation of the stapes, impairing its ability to vibrate and transmit sound effectively, resulting in conductive hearing loss.
Once the general anesthesia is administered, the surgeon makes a small incision, typically in the ear canal, to access the middle ear. In some cases, the incision may be made behind the ear for better visibility. The surgeon examines the eardrum and the ossicles (the three tiny bones of the middle ear) to assess their condition, which helps determine the best approach for the surgery.
The surgeon then carefully removes the immobilised stapes bone, which is often affected by otosclerosis, taking special care to avoid damaging the surrounding structures, including the other ossicles and the ear drum. After the stapes is removed, a prosthetic device (a small metal or plastic implant) replaces the diseased stapes bone. This prosthesis is designed to connect the incus (the second ossicle) to the inner ear, allowing sound vibrations to be transmitted effectively. Once the prosthesis is securely in place, the surgeon closes the incision in the ear canal or behind the ear, ensuring that it is secure and clean.
After the surgical procedure, patients are monitored for a short period to ensure they are stable and recovering well from anaesthesia. Most patients can go home the same day as the surgery. However, they should arrange for someone to drive them, as they may still feel groggy from anaesthesia.
First Few Days
Patients are usually advised to rest and limit physical activities for a few days. It’s essential to avoid bending over, lifting heavy objects, or engaging in strenuous activities to prevent complications. Some discomfort or mild pain may occur in the ear or around the incision site. Over-the-counter pain medications or prescribed pain relief can help manage this.
Weeks Following Surgery
Hearing improves gradually over several weeks. You may notice that your ability to hear fluctuates as the ear heals.
Full recovery and stabilisation of hearing may take several months. It’s important for patients to have realistic expectations about the timeline for hearing improvement.
Ongoing Ear Care
Patients are instructed to keep the ear dry for several weeks. This may involve using earplugs or cotton during bathing and avoiding swimming until cleared by the surgeon.
Follow-up visits are typically scheduled within a week or two after surgery to monitor healing and check the position of the prosthesis. Additional appointments may be necessary to assess hearing improvement.
The effectiveness of a stapedectomy surgery is assessed by determining the degree of hearing improvement achieved after the procedure. Most patients experience successful healing and a significant enhancement in their hearing acuity, often reporting a marked return to normal or near-normal hearing levels. However, in some instances, the improvement may be partial or temporary, with a small risk (around 1%) of complete hearing loss in the operated ear.
If a patient continues to feel a significant degree of hearing impairment following the stapedectomy, there is the option for revision surgery. Revision procedures can be performed with good outcomes, allowing the surgeon to address any issues that may have arisen during the initial surgery or to further optimise hearing. It’s important for patients to have realistic expectations and to maintain open communication with their healthcare team, as follow-up assessments and potential additional interventions can help ensure the best possible auditory results.
Our team of experienced otolaryngologists specialises in diagnosing and treating otosclerosis, ensuring that patients receive comprehensive evaluations and the most effective treatment options.
Our compassionate staff is dedicated to supporting patients throughout their journey, from pre-operative consultations to post-operative care, fostering a comfortable and reassuring environment. With a proven track record of successful surgeries and patient satisfaction, Complete ENT is the trusted choice for ear, nose and throat conditions.
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CompleteENT are a team of leading otolaryngologists who are proudly delivering outstanding care to adults and children with ear, nose and throat conditions in Queensland.