My 16 year old daughter had a cholesteatoma removed when she was 15. At that time it had deteriated the hammer and the anvil. Later surgery was done to replace these bones. That was done successfully, but the stirrup had calcified to the bone so that it doesn't move. We will soon see a specialist in Nashville, Tenn. What are the chances of repairing or replacing this bone? Is this an unusual occurrence or rare? She has very little hearing in that ear.
Thank you,
Reply: ------------------
You are describing an acquired fixation of the stapes bone due either to previous disease process (cholesteatoma) or due to scarring after surgical removal of the disease. This diagnosis was apparently arrived at during a second operation in which ossicular reconstruction was planned to restore hearing, at which time the mobility of the stapes bone was noted to be impaired. In my experience, it is unusual to find isolated stapes fixation with calcification during such "second-look" operations which are generally designed to verify removal of cholesteatoma as well as to reconstruct the ear bone chain, usually somewhere about a year after the initial cholesteatoma surgery.
It is certainly possible to surgically correct stapes fixation. This is performed during an operation known as stapedectomy. In this operation, the upper portion of the stapes bone is removed and a small fenestration is made in the bottom plate of the stapes which comes in contact with the fluids of the inner ear. A prosthesis (usually a type of piston) is then inserted in the fenestration and connected to the incus bone. The procedure is considerably more technically complicated when the malleus and/or incus are missing or have been replaced with prostheses and therefore warrants a referral to a surgeon with considerable stapes experience.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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