I had a stapendectomy 16 yrs. ago. Since my hearing has declined I had another hearing test & was told that I had a hole in my eardrum by my first doctor. I went for a second opinion & was told that I had no hole & that revision stapendectomy had only a 50% success rate. I went for opinion #3 & was told that I have no hole in my eardrum & that exploratory surgery could determine what could be done to improve hearing. Doc #3 believes that the success rate could be 80 - 90% for improved hearing. What are your thoughts? What are chances that hearing would get worse as a result of surgery? Although the doctor doesn't like using percentages he agreed that I have about 30 - 40% hearing loss. I trust doctor #3 but would be interested in an objective opinion on revision surgery or exploratory surgery, as he put it.
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First of all, it is important to know whether the primary cause of your decline in hearing is conductive or neurosensory loss. Stapedectomy is a surgical procedure in which the innermost ear bone known as the stapes is removed and replaced with a prosthesis. The procedure is most commonly performed in the treatment of otosclerosis which is a bone disorder affecting the bone surrounding the inner ear. In its early stages, otosclerosis typically causes primarily a conductive hearing loss due to interference in the normal transfer of sound energy from the ear drum through the ear bones to the inner ear. In the early stages the condition is localized to the bone surrounding the stapes. Inner ear function may be normal at this point. With time, the condition generally will also involve the inner ear bone causing neurosensory hearing loss which cannot be improved with stapes surgery.
If there is a significant conductive component to your hearing loss and the neurosensory function (measured by bone conduction thresholds on a hearing test) is still fair, revision stapes surgery is a reasonable consideration. The cause of a recurrent conductive hearing loss after previously successful stapes surgery may be related to dislodgement of the prosthesis, erosion of the incus bone where the prosthesis is attached, or regrowth of otosclerotic bone near the footplate where the stapes prosthesis is in contact with the inner ear fluids. Revision surgery can repair these types of problems. However, stapes surgery in general is a highly technical surgical endeavor. Not all otolaryngologists perform this type of surgery, and even those who do a reasonable volume of primary stapes surgery may not feel comfortable doing revision stapes surgery. If you are contemplating a revision stapes operation, I would strongly recommend you seek consultation with a surgeon, most likely an otologist, with a significant experience in stapes surgery specifically. This may necessitate asking very specific questions of the surgeon such as how many stapes procedures he/she does in a year, what has the surgeon's success rate been compared with that reported in the literature, etc.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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