eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Middle Ear & Mastoid

Middle Ear, Otosclerosis: Follow-up

Author: Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Contributor Information and Disclosures

Updated: Nov 7, 2008

Outcome and Prognosis

Commonly quoted statistics indicate that 90% of appropriately chosen surgical candidates enjoy a significant hearing improvement. Eight percent experience no significant hearing improvement. Up to 2% (including 0.2% who may experience complete sensorineural hearing loss in the operative ear) experience additional hearing loss.

Revision stapes surgery yields less-successful results than primary surgery. Typically, the air-bone gap is closed to within 10 dB in approximately 50-70% of patients who undergo revision stapes surgery. Most surgeons prefer to use conscious sedation anesthetic technique when performing revision surgery. Manipulation of the existing prosthesis that elicits severe vertigo intraoperatively may indicate adherence of the prosthesis to the underlying vestibule. Further manipulation or removal of the prosthesis may cause a tear in the membrane and resulting profound sensorineural hearing loss. Having the patient awake enough to report vertigo during this portion of the operation is advantageous in this respect.

Residual or recurrent conductive hearing loss after stapes surgery has many causes. The most likely cause is a migration of the prosthesis out of the stapedotomy and subsequent fixation against the residual footplate or otic capsule margin. This is thought to be due to a contraction of collagen within a neomembrane created between the prosthesis and the membranous labyrinth, which lifts the prosthesis out of the oval window fenestration. This may cause complete or partial erosion of the incus due to vibration of the incus against a fixed prosthesis. Alternately, incus erosion may occur as a result of vascular compromise of the bone due to an overcrimped prosthesis. Other causes include malleus or incus fixation or incus dislocation.

Future and Controversies

The following represent somewhat unresolved controversies. Exploration of each issue requires extensive discussion beyond the scope of this article.

  • Preoperative tuning fork examination as a prognosticator for surgical success
  • Laser stapedotomy minus prosthesis (STAMP) procedure in which the posterior footplate is detached from the diseased anterior footplate without disrupting ossicular chain continuity
  • Implantable hearing devices (Baha) that may produce adequate gain for amplification without the risks of stapedectomy
  • Endoscopic techniques now being applied to stapes surgery to further minimize morbidity

 


More on Middle Ear, Otosclerosis

Overview: Middle Ear, Otosclerosis
Workup: Middle Ear, Otosclerosis
Treatment: Middle Ear, Otosclerosis
Follow-up: Middle Ear, Otosclerosis
Multimedia: Middle Ear, Otosclerosis
References
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References

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Further Reading

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Keywords

otosclerosis, middle ear, otosclerosis of the middle ear, otospongiosis, total stapedectomy, partial stapedectomy, stapedotomy, otosclerosis, stapes, ankylosis, ear problems, hearing problems, plugged ear, blocked ear, clogged ear, deafness, hearing loss, progressive hearing loss, conductive hearing loss, progressive conductive hearing loss

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Contributor Information and Disclosures

Author

Jack A Shohet, MD, Associate Clinical Professor, Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine; Otolaryngologist, Shohet Ear Associates Medical Group, Inc
Jack A Shohet, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Tinnitus Association, and California Medical Association
Disclosure: Envoy Medical Consulting fee Consulting

Medical Editor

Cliff A Megerian, MD, FACS, Medical Director of Adult and Pediatric Cochlear Implant Program, Vice-Chairman and Director of Otology and Neurotology, University Hospitals of Cleveland; Professor, Department of Otolaryngology-Head and Neck Surgery and Neurological Surgery, Case Western Reserve University School of Medicine
Cliff A Megerian, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Association for Research in Otolaryngology, Massachusetts Medical Society, Society for Neuroscience, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gerard J Gianoli, MD, Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center
Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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