What is ostosclerosis? What are the complication of Stapedectomy surgery and describe brief how you will manage them. What is neo-stapedotomy?
Otosclerosis is a localized hereditary disorder affecting endochronal bone of the otic capsule that is characterized by disordered resorption and deposition of bone.
Clinical otosclerosis refers to a lesion that involves the stapes bone or stapedio-vestibular joint and consequently is clinical manifested by conductive hearing impairment.
Histological otosclerosis refers to a lesion that does not involve the stapes bone, stapediovestibular joint or cochlear endosteum, is consequently asymptomatic, and can be diagnosed only by post-mortem examination of the temporal bone.
Cochlear otosclerosis is a term generally reserved for the occurrence of pure sensory hearing impairment due to otosclerosis in an ear without any conductive component to the hearing impairment.
Capsular otosclerosis is usually associated with stapedial fixation and results in a mixed hearing loss which is invariably progressive in nature.
The complications of Stapedectomy surgery can be divided into:
Delayed onset occurs about 5 days post-operatively
Responds quickly to prednisolone
Full recovery over days to weeks
Usually last for few hours and subside rapidly
Rarely severe or prolonged
Usually only supportive management
Primary: at the end of surgery
Secondary: months or year later
Persistent fluctuant hearing loss, vertigo, sense of fullness
D/D : endolymphatic hydrops
Replace new prosthesis if displaced
Graft the defect
Common with gel foam or fat graft
Rare with perichondrium, fascia or vein
Presents 1-2 weeks after surgery
Suspect if symptoms of serous labyrinthitis fail to settle or progressive sudden SNHL or mixed
Dull red TM in postero superior quadrant
Steroids and antibiotics
Surgical intervention if no improvement within two weeks
Discomfort to loud noise:
Damage to stapedius tendon or
Improved hearing in operated ear
Alteration of taste:
Stretching of chorda tympani results more symptoms than sectioning
Symptoms severe if bilateral damage
Metallic taste, impairment or dry mouth or soreness of the tongue
Most resolve within 3-4 months
Implantation of skin element while harvesting fat graft
Due to fistula formation: exploratory tympanotomy
Tinnitus: preexisting which improves as ear heals, reassurance.
Neostapedotomy is a method of preserving the stapedius tendon for preserving the blood supply to the long process of incus and reducing discomfort at high sound pressure levels and of improving speech intelligibility. Tendon preservation may lead to a higher noise discomfort threshold (98 dB with tendon preservation ans 124.1 dB without)