What is stapedoplasty? This is a hearing-saving microsurgical operation, which is used for hearing pathology - otosclerosis. In otolaryngology it is used as one of the most effective methods of treatment and is used often. According to statistics, up to 2% of people in the world suffer from otosclerosis, and women predominate. Age of patients - young able-bodied people from 20 to 40 years. The disease is not among the common.
This is what stapedoplasty is. The operation is among the painstaking, requiring highly qualified surgeon and appropriate tools. With it, a partial or complete replacement of the stapes with a prosthesis is performed.
A bit of history
The problem of hearing loss remained such for a long time, until magnifying optics were invented and antibiotics were created. Until the end of the 19th century, operations were unsuccessful due to imperfect technology. The shift occurred in the second half of the last century, when stapedoplasty appeared - what it is, it was clear only to some specialists. It was proposed to replace the stirrup with a prosthesis. In this form, the operation is carried out today.
Anatomy
The ear begins with the auricle - the outer ear, and serves to direct the sound along the external auditory canal to the eardrum. The cartilage serves as the skeleton of the outer ear. Behind the eardrum, which has the ability to oscillate under the influence of sound waves, is the middle ear. This is a very complex device, the work of which is manifested in the perception of the wave and its transmission in the inner ear to the cochlea. In this case, the sound is amplified.
The complexity of the middle ear - in the presence of 3 tiny bones: a malleus, anvil and stapes, capable of transmitting sound. The stirrup is covered by the membrane of the oval window, with vibrations of both, the sound goes to the cochlea. It already forms nerve impulses for the brain. The brain is the ultimate authority; final processing and perception of sound takes place here.
To understand what it is - stapedoplasty, one must clearly imagine that in the entire device of the ear, the most vulnerable part in otosclerosis is precisely the stapes where sclerosis or an osteodystrophic process develops in the wall of the maze. Most often, foci of sclerosis are localized on the eve of the oval window, and affect the stapes. They restrict his movement. Because of this, the hearing is lost irreversibly.
Conservative methods of treatment for such a pathology are absolutely inconclusive. Its exact causes are unknown; heredity plays a role. The disease is characterized by excessive proliferation of sclerosing tissue in the stapes, as a result of which the sound ceases to be transmitted to the cochlea.
Types of Otosclerosis
Otosclerosis is of 3 types:
- conductive, or tympanal;
- mixed;
- cochlear.
With conductive otosclerosis, sound conduction is impaired. This violation is the easiest, the operation with it helps 100%.
With mixed otosclerosis, both the conduct and perception of sounds are disturbed. The operation can restore hearing, but not completely.
With a cochlear form, sound perception is sharply reduced. The operation is powerless.
Signs of otosclerosis
Suspecting onset of otosclerosis or otospongiosis can be suspected by some first signs: hearing loss and cod in the ears. The insidiousness of pathology is that the symptoms may disappear for a while, and it seems that recovery has come, but this is a hoax - the pathology continues to progress.
So, the symptoms of otosclerosis :
- Noise in the ears - it does not look like a pleasant sound of wind or surf, the rustle of leaves. He is sharp, constant even in silence, exhausting. Intolerable and resembles a constant crack. By the end of the day, it intensifies with a person's tiredness. It is considered the first stage and lasts 2-3 years. Hearing decreases slightly. There is a paradoxical syndrome with otosclerosis - improving hearing in a noisy environment. Next comes the 2nd stage, in which the hearing in the first ear is significantly reduced, and in the second, noise also appears. At first, low frequencies disappear - it is difficult to parse male speech, then high frequencies. It can last for decades.
- Dizziness with nausea is a very unpleasant and painful symptom. The head does not hurt. When driving in vehicles and with sharp turns of the head, head spinning is intensified. This symptom does not occur in everyone.
- Behind the auricle there is a pressing, bursting pain with a return to the back of the head. Symptom indicates the transition of otosclerosis to the acute stage, after which there will be a decrease in hearing. Moreover, whispering speech is no longer perceived, and sometimes conversational.
- Fatal stuffiness in the ear. It can be single or double-sided.
- Irritability is the result of the described changes.
At the onset of the disease, hearing decreases first in one ear, and subsequently in both.
What measures to take
The only effective treatment is stapedoplasty of the ear with removal of the affected bone. Sclerosis tends to progress, and conservative treatment loses its meaning. Even at the beginning of the pathology, it can only bring temporary improvement, but it does not cure.
The operation is effective in the first 2 forms. First, a hearing-impaired ear is operated on, and six months later, the second.
Indications
The indication is bilateral otosclerosis, adhesive otitis media and negative Rinne test (the sound of a tuning fork is heard louder through the bone). Adhesive inflammatory process is also characterized by the growth of fibrous tissue. However, the intervention is not for all otosclerotics.
The state of bone conduction is taken into account. It is determined by audiometry.
The operation is performed for patients with hearing loss of at least 25 dB in bone conduction and up to 50 in air conduction.
Contraindications for surgery
There are no absolute contraindications to stapedoplasty, it does not apply when:
- unilateral otosclerosis;
- active process flow;
- acute inflammation or relapse in ear diseases;
- general severe somatic condition of the patient;
- common acute infections;
- acute inflammatory processes, pustules in the external auditory canal;
- clotting disorders;
- oncology;
- acute external otitis media;
- good hearing in the second ear.
Examination before surgery
Before the operation, it is necessary to undergo tympanometry, audiometry, research with a tuning fork and radiography of the temporal bones, CT. All these studies are aimed at obtaining complete information about a sore ear.
A prerequisite for stapedoplasty is a good auditory tract. Immediately before the operation, intense auditory load on the ears, riding in the subway, airplane, and physical stress are prohibited.
Operation sequence
The operation is always planned. Anesthesia is infiltration. The first intervention is performed on a hard of hearing ear. The operation lasts about an hour. The work uses a laser and a surgical microscope.
Reviews about the operation of stapedoplasty are different. Some complain of discomfort throughout the procedure, but most patients feel absolutely nothing during the manipulations.
To penetrate the middle ear, the doctor lifts the eardrum. Then part of the stapes (or all stapes) is removed, which is replaced by a prosthesis.
Prosthetics stapes can be done in two ways:
- piston method with implantation of a biocompatible prosthesis;
- replacement of damaged structures with autotissues of the operated.
The latter technique is used more often after the age of 40.
Auto-cartilage is placed only in Moscow. With such an operation, there is no necrosis and complications. At the end of the operation, the doctor checks the level of hearing, and then the ear is plugged with a cotton swab for a week.
Prosthetics methods
There are two main techniques for stapedoplasty surgery: stapedotomy and stapedectomy. With stapedotomy, the anvil leg is captured by the loop of the prosthesis, and the leg of the prosthesis itself is lowered into the hole on the base of the stapes.
When stapedectomy, the leg of the prosthesis is placed on the flap of the periosteum or the walls of the veins, covering the window of the vestibule. The piston technique is mainly used for patients under 40 years of age. It is more often used in foreign clinics and is indicated for pronounced changes in the middle ear.
If the operation is unsuccessful, restapedoplasty is possible, but surgeons are very reluctant to take it. This is always fraught with great difficulties:
- there are already scars that will have to be cut again with the risk of dislocation and damage to the auditory ossicles;
- it is difficult to find an oval window;
- there is a risk of damage to the facial nerve.
Repeated intervention, even after a few years, is risky, and there is no guarantee that hearing will be returned.
Postoperative period
After the operation, the patient is transferred to the ward, under the supervision of staff. You need to lie only on the healthy side. By evening, the patient may feel noise and throbbing in the ear, which are considered normal. They pass by themselves in a few hours. The surgeon examines the ear every day.
The swab will be removed after a week, before discharge. After removing the swab, the doctor again checks the hearing.
Further verification will be carried out after 3, 6 and 12 months. Hearing is fully restored within 2-3 months.
In the postoperative period after stapedoplasty, rehabilitation will last another six months. During it, certain restrictions are observed:
- Do not be in places with excessive noise and vibration;
- listen to music without headphones, so as not to strain the ears;
- sports and physical activity are completely excluded during the first 3 months;
- the ear cannot be wetted;
- diving is prohibited forever;
- the first 3 months excluded flights by plane;
- Do not be in the pressure chamber;
- 2 months you can not ride the subway.
Even after successful stapedoplasty, conservative treatment is necessary as sclerosis continues. Within six months, the patient is regularly observed by a doctor. At the same time, preparation for surgery on the second ear occurs.
Complications
Ear surgery rarely has complications - about 1%:
- Early - occur after surgery in the early days in the form of dizziness, nausea, noise in the ear - they pass by themselves.
- Delayed complications are more complex and do not resolve themselves. Damage to the eardrum is possible - it goes away without treatment itself.
Among the complications are also:
- infected inflammation of the cochlea of the inner ear;
- acute otitis media;
- facial nerve paresis - facial muscle weakness and asymmetry from the side of the operation;
- occurs when the facial nerve is damaged during the operation;
- meningitis - inflammation of the meninges;
- discharge from the ears - with damage to the dura mater;
- obliterating otosclerosis - involvement in the process of an oval window;
- rejection of the prosthesis;
- hearing loss
- immune response to the implant in the form of necrosis or pressure sores.
How to prevent otosclerosis
It is difficult to isolate specific methods of prevention due to the uncertainty of the etiology.
Common measures include:
- ears should be protected from loud sounds and water;
- you can’t pick your ears even with cotton buds.
- it is necessary to timely treat inflammation in the ear.
Reviews
Reviews of stapedoplasty of patients who underwent surgery are very different. Many are very happy as their hearing improves by 80%. In 25% of patients with severe otosclerosis, hearing after surgery deteriorates - this is indicated by some reviews after surgery stapedoplasty. But for the most part, past stapedoplasty recommend using it to improve the quality of your life.