STAPEDOTOMY (with or without LASER) INFORMATION and

STAPEDOTOMY (with or without LASER)

INFORMATION and SURGICAL INFORMED CONSENT

Hearing is a very complex mechanism. Sound waves enter

your ear canal where they cause the tympanic membrane

(eardrum) to vibrate. The sound energy then gets amplified and

transmitted through three small middle ear bones (ossicles) to

the inner ear organ, called the cochlea, shown as the snail

shaped structure. Lastly, the sound travels along the auditory

nerve to your brain, where it is perceived as sound.

If you have a problem with any structure in the ear before the cochlea, you will have a conductive

hearing loss. Otosclerosis is a common cause of conductive hearing loss. It is an inherited disorder that

is twice as common in women. It causes excessive stiffening of the stapes bone, the smallest bone in our

body. When movement of the stapes bone is impeded (by extra calcification in otosclerosis), a

conductive hearing loss occurs.

Otosclerosis usually presents as a gradual onset of progressive hearing loss in one or both ears. If both

ears are affected by otosclerosis, they may be affected similarly, or to different degrees or have a

different time frame. Few types of hearing loss can be surgically corrected as well as otosclerosis. A

surgical procedure, known as laser stapedotomy, can usually correct most of the hearing loss related to

otosclerosis. Generally, the operation is curative for this condition. If a patient is not a candidate for the

surgery, or does not want to have surgery performed, wearing a hearing aid is also an option.

WHAT IS A STAPEDOTOMY?

Stapedotomy is an operation that creates an opening in the stapes bone, removing the upper portion of

the bone, then replacing the piston action of the original stapes (actually bypassing) with a prosthesis.

The middle ear cavity, enclosed on the outside by the tympanic membrane and the inside by the bony

wall of the inner ear, houses the sound conduction mechanism called the ossicular chain. These three

previously mentioned ossicles are suspended from the middle ear cavity by ligaments and muscles. The

Latin names of these three little bones are the malleus (hammer), incus (anvil), and stapes (stirrup). It is

interesting to note that the translations of the Latin names of these bones hint at their combined function

in transferring sound vibrations received at the eardrum to the inner ear.

The bottom of the stapes, called the footplate, makes direct contact with the inner ear, and it is at this

point that otosclerosis interferes with the transmission of sound. In otosclerosis, there is an overgrowth

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of bone around the footplate, causing the stapes bone to be fixed and unable to vibrate. Stapedotomy is

performed by bypassing the immobile stapes with an artificial piston prosthesis. A very small hole (<

0.8 mm) is created with a laser in the stapes footplate to allow for placement of the prosthesis. If you

have otosclerosis in both ears, only one ear will be operated on at a time, starting with the poorer one.

The second ear, if affected, can have the surgery performed a minimum of one year later, if desired.

Two weeks before surgery: Non-steroidal anti-inflammatory drugs (NSAID’s) should be strictly avoided

for 2 weeks prior to surgery. Medications in this family include: aspirin, ibuprofen, Advil, Motrin,

Alleve, and naproxen plus others. These medicines may increase the risk of bleeding. Also, discontinue

all homeopathic or alternative medicines such as gingko biloba or ginseng. These too, may increase

bleeding.

Night before surgery: No solid foods (that includes milk, cream, etc.) for 8 hours prior to surgery.

Typically this means no solid foods after midnight before the surgery. Small volumes of clear liquids

may be taken up to 4 hours prior to surgery. This includes water, tea, Gatorade and coffee (with NO

milk or cream).

Hospital stay: Stapedotomy is usually done as an outpatient and does not require an overnight hospital

stay. On occasion, a patient may need to stay overnight. Check with your insurance company to see if

this hospitalization is covered by your policy. A decision to admit overnight may be made after surgery

if necessary.

Lab work: If lab work is needed, it is done prior to surgery. If surgery is done as an out-patient, labs may

be obtained just after the preoperative examination. Your insurance carrier may dictate the lab where the

blood is drawn.

The indications and risks of surgery must be understood prior to proceeding with your surgery. The

alternative to this surgery is no surgery at all, which would leave your ear in its current condition.

Another option is to wear a hearing aid.

SURGICAL RISKS AND COMPLICATIONS

This type of ear surgery has very few serious risks. Complications from stapedotomy are infrequent and

typically related to the presence of uncommon variations in anatomy. Usually the surgical procedure is

performed without difficulty, with a high rate of success.

Excessive bleeding during this surgery is rare.

Post-operative infection is also rare. If this was to occur you could lose the hearing in the operated

ear. Once healed, it is unlikely that a middle ear infection would harm you.

Hearing loss: The incidence of total hearing loss reported is about one in 200 cases. Generally 90% of

patients find a significant improvement in their hearing after surgery. 5 to 10% of patients may not

experience an improvement in their hearing or a reduction in their hearing. If your hearing is not

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significantly improved after the surgery, a hearing aid can be obtained. If there is loss of hearing from

the surgery, a hearing aid would not benefit you. There is also a 1% chance over the years that

delayed deafness can occur. This would most commonly occur with a significant barometric pressure

change such as on a plane flight or scuba diving.

Dizziness/Vertigo: it is not uncommon to experience dizziness or vertigo for hours or days after the

surgery. Extremely rarely the dizziness would not resolve.

Eardrum perforation: there is a small chance your eardrum may develop a hole during surgery. Repair

of this would be attempted at the surgery however if it persists a second surgery might be necessary.

Tinnitus: tinnitus that was present before the surgery commonly persists, although following surgery

it may disappear. In rare instances it could be worse.

Facial nerve paralysis: injury to the facial nerve is extremely rare in stapedotomy. If this was to

occur your face would droop, be weak or be paralyzed.

Taste change: a nerve called the chorda tympani nerve runs directly in the middle of the operative

site, overlying the bones that are surgically manipulated. This nerve controls the taste function of the

front 2/3 of the tongue on the side of the surgery. If this nerve is either intentionally divided (which is

occasionally necessary) or stretched, you may experience a metallic taste for several months following

surgery. Unless you rely on your taste buds for your profession (such as a sommelier does), one-sided

loss won’t likely have any permanent noticeable alteration of taste or flavor. Loss of this nerve

function on both sides however, may leave a noticeable reduction in taste/flavor.

Laser fire: there is a very remote risk of fire when using any laser in surgery. Precautions are taken

to avoid this problem.

As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even

death are possible. Please discuss these risks with your anesthesiologist.

GENERAL POST-OPERATIVE INSTRUCTIONS/CARE

ACTIVITY: Very light activity for 2-3 weeks is recommended after your ear surgery. No excessive

bending, stooping, straining, or lifting more than 15 pounds during this time. Please avoid aggressive

blowing of your nose for one month after surgery. If your job entails a lot of bending or heavy lifting,

please notify us prior to your surgery. Ideally avoid plane flight for 6 weeks, even better for 3 months

following stapes surgery. If you are an airline pilot, sky jumper or scuba diver, please be sure to alert

your physician.

DIET: You can eat a diet as you tolerate after your ear surgery.

MEDICINES: You will be prescribed pain medicines and possibly oral antibiotics and/or eardrops.

Take these as directed. You may also be prescribed stool softeners. Take these as directed. Avoid

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heavy straining with bowel movements for several weeks.

BATHING: Generally, you may shower 24 hours after surgery. We do request you keep the ear dry

for 2-3 weeks after surgery or until instructed otherwise.

Post-operative follow-up: you will be asked to return to our office 7 to 10 days after surgery. There will also be

several visits over the next 4 to 6 weeks. If first post-operative visit has not already been scheduled, please call

our office to make that appointment.

At Suburban Ear, Nose and Throat Associates, Ltd., we go to great lengths to try to help you

understand your plan of care. If at any time during your care you have questions or concerns, please

call us at 847- 259-2530.

I have been given an opportunity to ask questions about my condition, alternative forms of treatment,

risks of non-treatment, the procedures to be used and the risks and hazards involved. I have sufficient

information to give this informed consent. I understand every effort will be made to provide a positive

outcome, but there are no guarantees.

Patient name PRINTED:

Patient SIGNATURE:

Date: Time:

Witness: Date: