What is stapedoplasty? This is a hearing-preserving 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 frequently. According to statistics, up to 2% of people in the world suffer from otosclerosis, and women predominate. The age of patients is young able-bodied people from 20 to 40 years old. The disease is not common.
That's what a stapedoplasty is. The operation is one of the painstaking, requiring high qualification of the surgeon and appropriate instruments. With it, a partial or complete replacement of the stirrup with a prosthesis is carried out.
A bit of history
The problem of hearing loss has been around for a long time, until the invention of magnifying optics and the creation of antibiotics. Until the end of the 19th century, operations remained unsuccessful due to the imperfection of technology. The shift took place in the second half of the pastcenturies, when stapedoplasty appeared - what it was 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 sound through the external auditory canal to the eardrum. The outer ear is cartilage. Behind the eardrum, which has the ability to fluctuate 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 to the inner ear to the cochlea. At the same time, the sound is amplified.
The complexity of the middle ear - there are 3 smallest bones: the hammer, anvil and stirrup, capable of transmitting sound. The stirrup is covered by the membrane of the oval window; when both vibrate, the sound goes to the cochlea. It already generates nerve impulses for the brain. The brain is the final authority, here the final processing and perception of sound takes place.
To understand what it is - stapedoplasty, one must clearly imagine that in the whole structure of the ear, the stirrup becomes the most vulnerable part in otosclerosis, where sclerosis or osteodystrophic process develops in the wall of the labyrinth. Most often, foci of sclerosis are localized in the vestibule, up to the oval window, and affect the stirrup. They restrict his movements. Hearing is permanently lost because of this.
Conservative treatments for this pathology are absolutely ineffective. Its exact causes are unknown, plays a roleheredity. The disease is characterized by an overgrowth of sclerosing tissue in the stirrup, as a result of which sound is no longer transmitted to the cochlea.
Types of otosclerosis
There are 3 types of otosclerosis:
- conductive, or tympanal;
- mixed;
- cochlear.
Sound conduction is impaired in conductive otosclerosis. This violation is the easiest, the operation with it helps 100%.
With mixed otosclerosis, both conduction and perception of sounds are disturbed. Surgery can restore hearing, but not completely.
With the cochlear form, sound perception is sharply reduced. The operation is powerless.
Signs of otosclerosis
It is possible to suspect the beginning of otosclerosis or otospongiosis by some first signs: hearing loss and cod in the ears. The insidiousness of the pathology is that the symptoms may disappear for a while, and it seems that recovery has come, but this is a deception - the pathology continues to progress.
So, the symptoms of otosclerosis:
- Tinnitus - it is not like the pleasant sound of the wind or the surf, the rustle of leaves. It is sharp, constant even in silence, exhausting. Unbearable and resembles a constant crack. By the end of the day, it intensifies when a person is tired. It is considered the first stage and lasts 2-3 years. Hearing is reduced slightly. There is a paradoxical syndrome with otosclerosis - hearing improvement in a noisy environment. Next comes stage 2, in which hearing in the first ear is noticeably reduced, and noise also appears in the second. First, low frequencies disappear - it is difficult to parse male speech, thenhigh. Can last decades.
- Dizziness with nausea is a very unpleasant and distressing symptom. The head does not hurt. When driving in transport and with sharp turns of the head, the dizziness intensifies. This symptom does not occur in everyone.
- A pressing, arching pain appears behind the auricle, radiating to the back of the head. The symptom indicates the transition of otosclerosis to an acute stage, after which there will be hearing loss. At the same time, whispered speech is no longer perceived, and sometimes colloquial.
- Unrecoverable congestion in the ear. 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, then in both.
What action to take
The only effective treatment is stapedoplasty of the ear with the 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 does not cure.
The operation is effective for the first 2 forms. First, the hard of hearing ear is operated on, and six months later, the second.
Indications
Indications are bilateral otosclerosis, adhesive otitis media and a negative Rinne test (the sound of the tuning fork is heard louder through the bone). The adhesive inflammatory process is also characterized by the growth of fibrous tissue. However, the intervention is not carried out for all otosclerotics.
Consider statebone conduction. It is determined by audiometry.
The operation is performed on patients with hearing loss of at least 25 dB in bone conduction and up to 50 dB in air.
Contraindications for surgery
There are no absolute contraindications to stapedoplasty, it is not used for:
- unilateral otosclerosis;
- active process;
- acute inflammation or recurrence in diseases of the ears;
- general severe somatic condition of the patient;
- common acute infections;
- acute inflammatory processes, pustules in the external auditory canal;
- blood clotting disorders;
- oncology;
- acute otitis externa;
- good hearing in the other ear.
Examination before surgery
Before the operation, it is necessary to undergo tympanometry, audiometry, a study with a tuning fork and radiography of the temporal bones, CT. All these studies are aimed at obtaining complete information about the diseased ear.
A necessary condition for stapedoplasty is good patency of the auditory pathway. Directly before the operation, intense hearing stress on the ears, riding in the subway, airplane, physical overstrain is prohibited.
Sequence of operation
The operation is always planned. Anesthesia is infiltration. The first intervention is performed on the hard of hearing ear. The operation takes 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 manipulation.
To penetrate the middle ear, the doctor lifts the eardrum. Then part of the stirrup (or the entire stirrup) is removed and replaced with a prosthesis.
Prosthetic stapes can be done in two ways:
- piston method with implantation of a biocompatible prosthesis;
- replacement of damaged structures with auto tissues of the operated person.
The latter technique is used more often after the age of 40.
Autocartilage is placed only in Moscow. With this 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.
Prosthetic Methods
There are two main methods of stapedoplasty surgery: stapedotomy and stapedectomy. During stapedotomy, the prosthesis loop is captured by the anvil leg, and the leg of the prosthesis itself is lowered into the hole on the base of the stirrup.
During stapedectomy, the leg of the prosthesis is placed on a flap of the periosteum or vein wall that covers the vestibule window. The piston technique is mainly used in patients younger than 40 years. It is more often used in foreign clinics and is indicated for pronounced changes in the middle ear.
In case of an unsuccessful operation, restapedoplasty is possible, but surgeons are very reluctant to undertake it. This is always fraught with great difficulties:
- already have scars that will have to reappearcut with the risk of dislocation and damage to the auditory ossicles;
- hard to find oval window;
- there is a risk of damage to the facial nerve.
Re-intervention, even after a few years, is risky and there is no guarantee that hearing will return.
Post-operative period
After the operation, the patient is transferred to the ward, under the supervision of staff. You need to lie only on the he althy side. By evening, the patient may feel noise and pulsation in the ear, which are considered normal. They go away on their own after a few hours. The surgeon examines the ear every day.
The tampon will be removed in a week, before discharge. After removing the tampon, the doctor checks your hearing again.
Further check will be carried out in 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:
- don't be in places with excessive noise and vibration;
- listen to music without headphones, so as not to strain your ears;
- sports and physical activities are completely excluded during the first 3 months;
- you can't get your ear wet;
- diving banned forever;
- air travel excluded for the first 3 months;
- you can't be in the pressure chamber;
- 2 months no subway ride.
Even after a successful stapedoplasty, conservative treatment is necessary as the sclerosis continues. For six months, the patient regularlyseen by a doctor. At the same time, preparations are underway for surgery on the second ear.
Complications
Ear surgery rarely has complications - about 1%:
- Early - occur after surgery in the first days in the form of dizziness, nausea, noise in the ear - they pass by themselves.
- Delayed complications are more complex and do not go away on their own. Possible damage to the eardrum - goes away without treatment.
Complications also include:
- infected inflammation of the cochlea of the inner ear;
- acute otitis media;
- paresis of the facial nerve - weakness of facial muscles and asymmetry on the part of the operation;
- occurs when the facial nerve is damaged during surgery;
- meningitis - inflammation of the meninges;
- discharge from the ears - if the dura mater is damaged;
- otosclerosis obliterans - involvement in the process of the oval window;
- denture rejection;
- hearing loss;
- immune reaction to the implant in the form of necrosis or bedsores.
How to prevent otosclerosis
It is difficult to single out specific methods of prevention due to the ambiguity of the etiology.
General measures include:
- should protect your ears from loud sounds and water;
- you can't pick your ears even with cotton swabs.
- it is necessary to treat inflammation in the ear in a timely manner.
Reviews
Reviews about stapedoplasty of patients who have undergone surgery are very different. Many are very satisfied as hearing improves by 80%. In 25% of patients with severeotosclerosis, hearing worsens after surgery - some reviews speak about this after stapedoplasty surgery. But for the most part, those who have undergone stapedoplasty recommend using it to improve the quality of their lives.
