#stapedotomy

Background: Sudan has been performing endoscopic stapedotomy for otosclerosis since 2011, with a growing number of patients. In this prospective hospital-based study, which spans from November 2016 to November 2020, the clinic-demographic characteristics of otosclerosis, as well as the surgical method and hearing result following endoscopic stapedotomy, are discussed.

The total number of patients enrolled in the trial was 91. With a female to male ratio of 1.1:1, females were 48 and males were 43. The participants' ages ranged from 19 to 52, with a mean age of 30.6 7 SD years. The most common symptom was reduced hearing in all patients (100 percent); it was bilateral in 82 patients (90 percent), followed by tinnitus in 80 patients (88 percent), and vertigo in two patients (2.2 percent). Only two patients (2.2 percent) mentioned their family history. Audiological evaluation by pure tone audiogram (PTA) for each ear (total of 182) found that conductive hearing loss (CHL) was the most prevalent form of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), and normal in four ears (2.2%).

Endoscopic stapedotomy was performed on 74 patients; it was a safe procedure with only a few complications: one gusher and one revision, and no facial nerve injury. During the first year, the majority of difficulties occurred. The average air bone gap (ABG) increase was 23.3 7.2 decibels, the average air conduction (AC) gain was 18.3 dB, and the Carhart notch vanished in 79.5 percent of the cases.

I am a drummer who has chosen for a stapedotomy

Read about my adventure.

In de achtertuin van het Sint Augustinus ziekenhuis, wachtend op een stapedotomie ..... spannend, stress, angstig, .... hopend op een goede afloop en nog vele jaren drumplezier.

Are you drummer/musician and wondering whether you should go for a stapedotomy? I’ll post my experience in this post.

Post OP - Day 1

They ‘re having trouble stopping the bleeding. For the rest I feel fine, no dizziness, no pain, no balance disorder like most people experience. The left side of my head feels like it is paralized. At this point the excessive bleeding worries me the most....tomorrow there will be a hearingtest to see the result of the operation.

Mijn bloed wil niet stollen, net bloedverdikkers gekregen, hopelijk werkt dit. Ook morgen krijg ik pas verder nieuws over het resultaat van de operatie. Verder blijven de duizeligheid en evenwichtsstoornissen waar de meesten last van hebben achterwege. Ik voel wel een verdoofd gevoel over de linkerkant van mijn hoofd. 

Post OP - Day 2

Still bleeding, hearingtest is planned for today and I should be able to go home if everything is allright. Feeling some paralysis in the face and the taste of food is somewhat strange, my sandwich with chees tasted like a cup of salt :-) The nurses hadn’t experienced that much bleeding with other patients they told me. They litterally had to change the plaster every hour so I ended up with a lot of bondage around my head to minimalize the cleaning up.

De nachtverpleging zag het niet zitten om elk uur de plakker te komen verversen. Ze hebben me goed ingedraaid. De hoortest is gepland voor vandaag en waarschijnlijk ook terug naar huis. Eten is een vreemde ervaring, mijn broodje met kaas smaakte als puur zout. 

At the end of the day they did a hearingtest, I heard them say one frequency was damaged during operation but not that much that I would need cortisone....not sure what that means. Is this frequency lost forever or will it return ?? My thoughts still primarily went towards the trouble of the bleeding that they couldn’t stop and I still felt some paralysis on the left side of my face. At this point my brain repeatedly said to myself : OMG, what have I done to myself ??!!! With these thoughts they send me home for further recovery, with  some extra plasters to hold the excessive bleeding....next consultation is planned within a few days.

Aan het einde van de dag kwam dan de hoortest. Bloeding kregen ze nog steeds niet gestopt met als gevolg terug een nieuwe wiek in het oor voor een week. Uit de hoortest kwam de mededeling dat het binnenoor op een bepaalde frequentie beschadigd was door de operatie. Niet erg genoeg om cortisone toe te dienen ??? Even schrikken om dat te horen, hier was voor de operatie niet over gesproken over dit deel van de operatie en er werd ook niet dieper op ingegaan of dit blijvend of van voorbijgaande aard was. Mijn gedacht ging op dit moment vooral naar de bloeding die ze niet konden stoppen en de lichte verdoving over de linkerhelft van mijn gezicht. Het enige wat er door mijn hoofd ging op dat moment was : “OMG wat heb ik mezelf aangedaan ???!!!” Met deze gedachten hebben ze mij naar huis gestuurd voor verder herstel, met een deel extra plakkers voor het bloeden thuis op te soppen. Volgende consultatie is gepland binnen enkele dagen.

Post OP - Day 3

A good nightsleep in my own bed. And furthermore the first night without having blood dripping through the bandages. The paralysis from the previous day is gone I believe....I can tell you, at this point you ‘re not sure anymore what you’re body is telling you !! My energy level is very low, walking around like an 80 year old grandpa.

Een goede nachtrust in eigen bed, nog eens goed kunnen slapen, voor de eerste keer sinds de operatie. Dit vooral omdat het ook de eerste nacht was waarin het bloed niet voorbij de wiek geraakte, geen gedrup en gesmodder dus tijdens de nacht. De verlamming aan mijn gezicht lijkt verdwenen. Energie heb ik op dit moment niet, ik loop rond als een oud mannetje van 80 jaar. Ik had zoveel dingen gepland (kleine klusjes) die ik tijdens mijn herstel wou doen, maar het zal voorlopig vooral rusten worden !! Het huishouden rechthouden in mijn kleine dierentuin vergt zelfs al teveel energie op dit moment.

In the afternoon , after doing some phonecalls, daily household stuff, my body was completely empty, I had to go to bed. Clearly day 3 is too early to go walking around, even doing nothing heavy. After a nap I felt a bit better again.

In de namiddag voelde ik mij plots heel slap worden, ik had schrik dat ik ziek ging worden en dat is nu met die open wonde absoluut te vermijden. Ik had nog niet veel gedaan die dag, buiten wat gewandeld in de tuin, wat telefoontjes, wat bezig zijn met de katten....en toch rond 15u ging het niet meer. Ik moest bed in, mijn lichaam wou niet meer mee. Na een kort dutje ging het terug wat beter.

Post OP - Day 4

The bleeding has worsened a bit, but not in that kind that is dripping again, so not a point of real worry for me today. Energy level seems to be okay, but there still a long afternoon ahead. A sneeze caught me by surprise this morning and I clearly felt a “plop” in my ear. I hope this didn’t cause any damage or setback because sneezing, like blowing your nose is on a list of things NOT to do in the first weeks. In a worried state of mind I searched on the internet if there was some more info on the consequence of sneezing after stapedotomy. Didn’t find anything about that. Stumbled on a nice overview of things NOT to do though :

Avoid undue fatigue or exposure to colds or upper respiratory tract infections if possible.

It is best to not blow your nose for approximately one week. If absolutely necessary, blow your nose gently, one side at a time, with your mouth open.

Any accumulation of mucous in the nose should be drawn back into the throat and expectorated through the mouth to avoid infecting the ear.If it is necessary to sneeze, do so with your mouth open. Do not hold your nose to avoid sneezing

Do not play wind instruments, fly in an airplane, or swim for 3 weeks. Do not sky dive or scuba dive in the future without discussing the activity first with your surgeon.

Do not sleep on the side of the operated ear for one week.

Avoid heavy lifting, greater than 20 lbs., for one week following your operation.

A soft washcloth with warm water may be used to clean the outer ear as often as necessary for cleanliness and comfort. Do not use oil or allow water to enter the ear canal.

Do not allow any water to enter the ear canal for 6 weeks after surgery.

You may shampoo your hair 2 days following surgery provided that water is not allowed to enter the ear canal. Water can be kept out of your ear canal by placing a cotton ball in the ear opening and applying Vaseline® over the cotton to form a watertight seal.

If eardrops are to be instilled, position the head with the affected ear up during the instillation and remain in this position for 5 to 10 minutes to facilitate the absorption of the drops. Then, place a clean cotton ball in the ear canal for about one hour.

The ear should be exposed to the air as much as possible. A cotton ball should be placed in the ear canal during the day while combing the hair, during exposure to a dusty environment, and at night to prevent drainage onto your pillow. There may be red-tinged drainage from your ear. If this persists longer than four days or becomes thick, green, or yellow, please call your physician.

After ear surgery, your equilibrium may be affected. You may experience periods of vertigo or dizziness for the first several days. Take the necessary precautions to prevent injury if these symptoms are present. If the vertigo should last more than 3 days or become progressively worse, please call our office at 336-273-9932. You may notice the disequilibrium upon standing up or when turning your head from side-to-side. This is common and should resolve within the first week.

Do not be concerned about your hearing for 3 weeks following your procedure. Your hearing may improve or fade at various times during the first 3 weeks. You may hear cracking and popping sounds in your ear for several weeks. At times, it may sound like your head is "in a barrel" or that you are "talking in a tunnel." All of these sounds are normal and are not cause for concern.

If your physician has prescribed an antibiotic, fill the prescription promptly and take all of the medicine as directed until the entire supply is gone.

Because a nerve for taste passes through the ear, it is not unusual for taste sensation to be altered slightly for several weeks or months following the operation. You may notice a "tinny" or "metallic" taste in your mouth for up to several months that will usually go away spontaneously.

During the week following your procedure, some blood-tinged drainage from your middle ear may travel down your Eustachian tube and enter the back of your throat, especially during sleep. You may expectorate some blood-tinged mucous in the morning while brushing your teeth. This is common and will resolve spontaneously.

Please do not insert your hearing aid into your ear canal of the operated ear until approved by your surgeon.

De dag begint al slecht, uit het niets moest ik ineens niezen. Dit staat op de lijst van things NOT to do tijdens de eerste weken na de operatie. Dus nu een beetje bezorgd of ik hiermee schade berokkend heb of het genezingsproces vertraagd heb. In mijn zoektocht op het internet naar een verhaal over niezen na stapedotomie kom ik op een mooi lijstje (zie de engelse versie hierboven) uit van dingen die je zeker moet vermijden na de operatie. Er is echter niets te vinden over de gevolgen van het niezen. 

Post OP - Day 5

The most difficult thing for me and probably also the most dangerous part of this stapedotomy is the list with things you should not do after the operation. Besides a sneeze , I also blew my nose very gently yesterday because it was a bit stuffy. Since that moment I experienced some severe dizziness. 

Het moeilijkste en waarschijnlijk ook het meest gevaarlijke aan deze hele operatie is het proberen vermijden van de dagdagelijkse dingen die je niet meer mag doen zoals niezen, neus snuiten, iets heffen ..... daar zondig ik onbewust wel eens tegen. Gisteren was mijn neus een beetje verstopt en ik wou lichtjes men neus snuiten en sindsdien heb ik ook last van duizeligheid.

Post OP - Day 6

Dizziness disappeared during the day, but at the end of the day it came back. maybe because I again blew my nose gently ? Or was it not gently enough ? If you’re reading this before or after a stapedotomy, keep in mind this is not what you wanna do.

Duizeligheid verdwenen, maar op het einde van de dag liep men neus zo hard dat ik toch de zakdoek erbij haalde en lichtjes probeerde  te snuiten. Dit moet je dus echt niet doen na een stapedotomie.

Post Op - Day 7

......

Week 2

I’m gonna stop writing on a daily basis, my body isn’t that tired anymore, starting to do things again, so less time to write :-) .... I ‘ve had my first consultation since the operation at the beginning of the week. Doctor said the wound looked good. It finally stopped bleeding. Too early to expect something from my hearing though. I’ve been told that I wont hear properly the first month and that it is a slow healing process . My feeling : “It’s a fucking understatement, I’m completely deaf in my left ear !!!!!” .But ‘Patience’ they tell me .... I really hope they’re right 

I also (is this a sign from .... ?) met a co drummer I used to work with some 20 years ago . He was very interested in my story. He told me he had to give up drumming because his ear was damaged over the years due to too loud music without protection. He had an hearing aid ,  and started telling me about how terrible the sound is with that hearing aid. He would sometimes turn it off because the terrible  sound drove him crazy .... hearing this I thought to myself, “yes, I made the right choice with the operation”. But for the moment it looks worse, not hearing , but let’ s believe the doctors and hope my hearing will slowly come back, and grow to it’s full potential over the next 12 months :-)

Ik stop met het dagelijks updaten van deze blog. Mijn lichaam komt terug op gang, niet meer zo moe van de operatie. Ik ben op controle geweest aan het begin van week 2 en de dokter zei dat de wonde er goed uit zag .... en dat ik de komende maand niets moest verwachten van mijn gehoor. Dat had ik al door, ben compleet doof links !! Maar de dokter zegt geduld te hebben, het zou wel goed  komen!

Als bij toeval kom ik diezelfde week een collega drummer tegen in de winkel. Hij luisterde met volle aandacht naar mijn verhaal.  Zijn gehoor was beschadigd door geluidschade van zijn drummen zonder bescherming en draagt een gehoorapparaat. Hij werd zo gek van de slechte geluidskwaliteit dat hij zen hoorapparaat  geregeld af zette. Dat  horende dacht ik bij mezelf, mmm , misschien toch wel een goede keuze, mijn operatie (toch als alles goed komt).

Week 3

No real change in my condition in the middle of week 3, still no hearing in my left ear, still a loss of taste and a feeling of some pressure in my ear. Still having trouble avoiding simple things like sneezing and finding a balance between rest and (too strained) activity.

Woke up this morning with a fever blister, I  don’t hope this ends up in becoming sick which can have an impact on my operated ear. Searching the net again but nothing to find on this matter .... reading another testomonial from another patient results in knowing the difference between a stapedectomy and a stapedotomy ! The last one (the one I had is done by laser.

Here’s the link to this other blog I found : 

http://www.johngaltproductions.com/stapedectomy.html

Today I did some drumming on my meashed kit, a fast drumfill caused my head to move in a way that it shouldn’t have I guess, feel dizzy since that drumfill, the rest of the day sucks. I do hope so hard the dizzy feeling disappears tomorrow.

At this point I still feel some regrets having this operation done. But hey, let’s hope for the better tomorrow.

Week 5

The healing of my ear has started ! Finally some good news. I had my first hearing test since the operation in week 4 and the graphics showed that my hearing improved a little bit. Also loud noises don’t hurt that much anymore (even playing on my dampened drumkit hurted sometimes), that seems to be gone. Didn’t play on my real drumheads yet but I will find out soon because the first gig since the operation is coming up in a week.

Still a loss of taste though, but that would gradually disappear as my ear continues to heal over the next months. The ringing in my left ear that disappeared in the 2 first weeks after the operation has come back unfortunately, but let’s hope it goes away again :-)

The human ear is one of the great wonders of the human body for it shows how creative the creator of the human body is. It also shows how the evolution of the human body is quite a complex evolution that has culminated into the development of one of the finest and highly efficient organs of the human body called the "ear." You may not appreciate the great wonders that are happening every time you hear something on your ear, because you may not be truly and totally cognizant of the great magic that occurs inside your ear. But if you would carefully consider how the sound waves that enter your ear are transformed into electrical signals by your inner ear, you would surely be taken aback by how wonderful this transformation is. You would only appreciate such wonder when you suddenly lose the functionality of your ear and become deaf. Oblivious to sounds, you would no longer hear the music and the voices of your loved ones, and you would surely long for the time that your ears, both left and right, were still functional.

Importance of the Human Ear to a Holistic Existence

Humans have the tendency to take for granted something until that something is gone. In the same manner, many people seldom appreciate the magical hearing process of their body until these people lose partially or totally their sense of hearing.

Some people were born deaf and once they gain the use of their hearing organ via surgery, they become profusely appreciative and thankful of the gift of hearing. Likewise, there are people who are hard of hearing due to congenital defects. These people too manifest great thankfulness after having their congenital defects corrected via surgery.

Stapedotomy is one of the surgical procedures that aim to remedy the hearing problem of some people. This surgical procedure is performed on the middle ear to make the stapes’ footplate more flexible. Tympanoplasty is another surgical procedure designed to reconstruct the eardrum and the small bones located in the middle ear. Both these two middle ear surgeries often make use of CO2 lasers.  

There are many diseases that may affect the middle ear and some of these diseases include Cholesteatoma, eosinophilic otitis media, Otitis Media and many more, and some of these diseases may cause partial or total hearing loss.

How is Tympanoplasty Performed?

The medical uses of lasers have definitely expanded in the recent years, thanks to the hard works and researches done by both medical as well as manufacturers of medical lasers. It would be impossible to come up with functional and workable medical lasers without the necessary collaborations between medical experts, engineers who design, and companies that manufacture the different medical laser equipment. Just like any other equipment that is produced for different industries, a medical laser starts with a prototype laser that is then tested. If proven to be effective and efficient for medical usage, only then the actual manufacturing of the laser equipment would begin. But the conceptual and manufacturing process of medical lasers definitely undergo several stages before an actual laser is used on the surgical table.

Since medical lasers are usually used in performing sensitive surgical operations that require utmost precision, it is therefore imperative for manufacturers to produce laser equipment that can function precisely and efficiently during surgery. If you would look at how delicate the human body is, you would readily know how sensitive and how crucial the role played by medical lasers in the success of surgical operations. The eye, for example, is one organ of the human body on which lasers are used during eye treatments for diseases like glaucoma. Hence, it is important that laser equipment should function with utmost precision when used in eye surgery.

Another therapy that requires utmost precision is that of middle ear therapy or stapedotomy. Stapedotomy is one of the procedures performed to improve hearing. One malady that usually affects hearing occurs when the stapes footplate is not flexible, but fixed in its position. The stapes footplate normally should be mobile. In case the stapes footplate is fixed, there is a need to remove the stapes bone and replace the bone with micro prosthesis. This process is called stapedectomy.

Further Understanding Stapedotomy  

Stapedotomy is a modified stapes operation which most surgeons consider to be safe and can reduce the complications after surgery. Using laser or a microdrill, the surgeon usually drills a tiny hole on the footplate. Afterwards, the surgeon places a prosthesis that allows this area to absorb movement from tympanic membrane. The process of stapedotomy starts with injecting anesthetic into the skin of the ear canal. The purpose of this anesthetic is to enable the surgeon to reach the bone of the stapes by first lifting the eardrum and the canal skin to expose the bone of the stapes. The skin is first cut or incise before it can be lifted. The incus afterwards is disconnected from the stapes. A laser is then utilized to detach the stapes superstructure while deliberately preserving the footplate of the stapes. Then once again, the laser is utilized to drill a specific hole on the footplate of the stapes. Lastly, an implant is then attached to the hole and secured to the incus bone. Then, the eardrum and canal skin are returned to their former position. Lastly, this surgical procedure is usually complemented by the utilization of tissue graft seal. The laser stapedotomy is already one of the favorite procedures performed by surgeons to remedy middle ear malady and it is already a well-established medical procedure of ear surgery.