Surgery for Otosclerosis

What can be done about Otosclerosis?

In the early stages otosclerosis may not need treatment. The hearing loss may only be minor and the specialist may decide simply to keep you under observation.  In most cases the hearing loss will progress and at some point something will need to be done. The two treatments available are:
1: a hearing aid
2: an operation
Some specialists like all patients to try a hearing aid first and reserve surgery for those who, for whatever reason, do not get on with an aid.  However many patients do not like the thought of having to wear a hearing aid and therefore opt for surgery.

What does the operation involve?  

Using an operating microscope the surgeon lifts up the eardrum.  Often a small amount of bone needs to be scraped away to get a clear view. At this stage it is important to confirm the diagnosis and check that it is otosclerosis that is causing the problem. Using delicate instruments and preferably a laser the upper part of the stapes can then be removed. In order to re-establish the chain for transmission of the sound waves a small hole is made in the remaining part of the stapes (the footplate).

What happens after surgery?

It is quite common to feel a little dizzy after the operation although with a local anaesthetic this is usually very minor and many patients feel well enough to go home the same day. Dizziness is usually elicited by rapid head movements and so it is advisable to rest and avoid strenuous activity.  It is also worth avoiding anything that might increase pressure in the head like straining or heavy lifting.  If you need to sneeze try to do so through your mouth to minimise the pressure effect on the ear.  It is customary to stay off work for a couple of weeks although this will depend upon the nature of your work.  During this time the hearing is likely to be muffled due to the packing in the ear. After two weeks the packing is removed from the ear and an improvement in the hearing is usually apparent however it usually takes several weeks for the hearing to settle completely and there are often fluctuations in hearing over the first few weeks.

How successful is the operation and what are the risks?

In general the operation is very successful with over 90% of people experiencing a good improvement in hearing.  Sometimes the hearing remains unchanged and there is a small (approx 1-2%) chance of hearing loss.  Hearing results vary from surgeon to surgeon and it is important to ask your own surgeon about his own results and how often he carries out the procedure. As with all operations the best results tend to be achieved by those who do the procedure most frequently. Dizziness, which is experienced by most patients for a short time after the operation, may persist and become troublesome but again this is a rare complication.  The nerve that supplies the taste buds at the front of the tongue can be damaged. Usually this is only temporary but occasionally the nerve will have to be cut and a permanent loss results. The nerve that moves the face is located very near to where the surgery is taking place but it is extremely rare for this to be damaged. Sometimes the nerve may be abnormally sited and this may mean that it is not possible to complete the operation. This is not an exhaustive list and it is important to ask your specialist about other possible risks and complications.

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