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A CO2 Laser is used to weaken small areas of the bone so that the stapes arch comes apart from the incus and stapes footplate with less trauma. A CO2 Laser is used to weaken a focal spot in the stapes footplate so that the inner ear can be opened with less trauma. The hole into the inner ear (stapedotomy) through the stapes footplate is ready for the soft tissue layer and prosthesis.
Otosclerosis may cause hearing loss in children and adults with an incidence of about 8 per 100,000 population per year. The abnormal bone growth dampens the vibrations of the stapes bone, causing a hearing loss. Otosclerosis seems to be an inherited problem that is triggered by a viral illness, perhaps the measles virus.
An otolaryngologist working with an audiologist provides a combination of history, physical examination, and hearing tests that make the diagnosis.
Otosclerosis is one of several diseases where lower frequency tuning forks are heard more loudly through the bone behind the ear than through the ear canal. In stapedectomy, the surgeon removes the entire fixed stapes and replaces it with a prosthetic device that will allow sound waves to be passed on to theinner ear. A partial stapedectomy usually removes the arch of the stapes bone and a portion of the stapes bottom plate. Stapedotomy removes the stirrup-like arch and places a tiny hole in the bottom plate of the stapes.
In all three approaches, the surgeon replaces the stapes bone with a prosthesis attached to the remaining footplate of the stapes and to the incus (anvil bone). With a KTP laser (potassium titanyl phosphate crystal), the surgeon creates 0.2 millimeter openings in the footplate of the stapes. The prosthesis preferred at the Tampa Bay Hearing and Balance Center is a cup shaped prosthesis. The Bartels Titanium Bucket Handle Prosthesis combines desirable features of several stapes prosthesis types. Prior to the Bartels Titanium Bucket Handle Prosthesis, no prosthesis existed that could adjust to the varying size of the incus tip. The alternative to stapes bucket is a group of so called crimpable stapes replacement prosthesis, usually shaped like a shepherd's crook.
The value of the crimpable prosthesis, though, is its ease of insertion through a smaller opening in the stapes footplate than would be feasible with the bucket type prosthesis. No lifting, pushing, bending, stooping, or use of an easy chair for two weeks after surgery. The ear usually hears better immediately after surgery, but temporarily declines as the middle ear fills with fluid.


The hearing loss type is called conductive because it affects the mechanism that conducts sound from the ear drum membrane to the inner ear. While otosclerosis tends to run in families, most blood relatives are free of the disorder.
A complete audiology examination includes an audiogram with speech testing, and a tympanogram (middle ear flexibility and pressure test). These results, along with the physician's exam, allow the physician to make a diagnosis of otosclerosis with a high degree of certainty. Three surgical procedures can be done for otosclerosis: stapedectomy, partial stapedectomy, or stapedotomy.
The cup attaches to the incus while the stem sits on the soft tissue seal of the inner ear.
The hearing bones are built to transfer energy through the tip of the second hearing bone (the incus) to the top of the third hearing bone (the stapes). The slotted design in the Bartels bucket has malleable tines that can be adjusted to fit almost any size incus. The shepherd's crook and other prostheses in this category fit to the longer body of the second hearing bone, the incus, and carry some long term risk that a less than ideal fit may wear the attachment site out.
The Bartels Titanium Bucket Handle Prosthesis combines the ability to use a smaller stapes footplate opening with the goal of a lower long term risk that the prosthesis would wear through the incus. Bartels believes that the titanium slotted bucket design with a piston tip will provide a uniquely special and broadly applicable prosthesis for stapes surgery. Sometimes, otosclerosis may also damage the sensory hair cells in the inner ear, causing sensorineural hearing loss. The surgeon generally decides which to perform based on experience and findings at surgery.
All three surgeries are done through the ear canal under high power magnification with a surgical microscope. To the left of the prosthesis, a portion of the soft tissue that seals the inner ear can be seen.
When the stapes bone must be replaced to restore hearing for a disease called otosclerosis, the prosthesis type that transfers energy from the incus tip (lenticular process) to the inner ear is called a "bucket" prosthesis. The common challenge in the use of traditional bucket-style stapes prostheses is that the fit to the incus is commonly a bit loose. Vibrational energy with a slightly loose prosthesis along the shaft of the incus may very slowly wear through the bone. No strenuous exercising, and no activities that require straining for the first six weeks after surgery.
Asians and people from the Indian subcontinent are more prone to develop the disease, as well.


The high frequency sounds are usually worsened next, while the middle range frequencies are the last to be affected. General anesthesia allows the person to sleep during the procedure, which takes generally less than an hour.
The Bartels design allows the fit to be adjusted to an accurate fit with the goal of better sound energy transfer.
Remove the ear opening cotton and any wick present - leave nothing in the ear, but do not clean the ear with a Q-tip. Notify the doctor immediately if the drainage becomes yellow in appearance, has a foul smell, or if bloody drainage seems excessive.
Sensorineural hearing loss may develop years after a successful operation that satisfactorily repairs hearing conductive mechanism.
Commonly, the physician also uses tuning forks to compare hearing through the bone behind the ear with hearing through the ear canal.
After surgery, about an hour in the recovery room is followed by two to four hours in the ambulatory outpatient surgery area. Keep water out of the ear - use a Vaseline - petroleum jelly - soaked cotton ball to plug the ear for bathing. Plan to return to work after a week if work does not require any heavy lifting or straining.
Use pain medication only as needed: Tylenol or equivalent for less serious pain and stronger pain medicine as prescribed. Some other causes of stapes bone fixation may be corrected at least in part with surgery, such as osteogenesis imperfecta.
If dizzy, do not drive until quick head turns can be made without disturbing ability to focus.
Even when sensorineural hearing loss is present, surgery may improve the conductive hearing loss sufficiently to allow more effective use of a hearing aid. At two to eight weeks after surgery, the middle ear fluid reaction to surgery gradually clears. Pat it dry and coat it with Polysporin, Bacitracin, Neosporin or similar antibiotic ointment after bathing (remember to keep water out of the ear with Vaseline soaked cotton, though.) If the incision becomes red, call the doctor.
In order to prevent placing any strain on the surgical site, avoid blowing the nose vigorously.
Sometimes, taste disturbance occurs, but usually clears within a few weeks to a few months.




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02.11.2013 admin



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