The middle ear has three small bones, the malleus, the incus and the stapes, which contribute to the formation of the auditory chain. Their main role is the transfer of sound waves from the eardrum to the inner ear. The abnormal reformation of these bones in the middle ear causes a pathological condition defined as otosclerosis. This condition in the early stages is treated conservatively, however, if the symptoms do not improve, then surgery is recommended. The procedure of choice in this case is called stapedectomy.

Otosclerosis: How it is caused

In otosclerosis, abnormal bone reformation disrupts the ability of sound to travel from the middle ear region to the inner ear. In this particular condition, one of the auditory ossicles, usually the stirrup, is replaced by a pathological bone, causing it to buckle and greatly restrict its movement. If the condition progresses, this abnormal reformation of the bone extends deeper into the ear, affecting the cochlea. This condition is called cochlear otosclerosis. Otosclerosis forms either in one of the two ears, or more often in both, and its formation is often related to a genetic predisposition.

Otosclerosis is caused when one of the bones in the middle ear, the stapes, becomes kinked in place. The staped begins to fuse with the surrounding bone, eventually becoming unable to move. When this bone cannot move, sound is no longer transmitted effectively to the inner ear and consequently hearing is significantly reduced.

Otosclerosis: Symptoms & Conservative treatment

The main symptom of otosclerosis is conductive hearing loss which gradually worsens over time. At the same time, there is particular difficulty in listening to low, deep sounds and whispers, while the patient may often hear tinnitus, i.e. sounds, such as humming, coming from inside the body, while sometimes the patient is experiencing dizziness. Mild otosclerosis can be treated with a hearing aid that amplifies the sound.

Stapedectomy: Surgical procedure

Often the condition does not go away with conservative measures, which makes a stapedectomy surgery necessary. For the specific surgery a special otoscope is used to facilitate the delicate manipulations required to complete the procedure. During the procedure, the eardrum is first lifted and the affected bone, i.e. the stapes, is located. The stirrup is then detached from the rest of the acoustic chain and carefully removed. After its removal follows its replacement with a prosthetic material usually of metal origin.

The special prosthesis is inserted to bypass the abnormal bone and allow sound waves to travel to the inner ear and restore hearing. The continuity of the acoustic chain is restored and the tympanic membrane returns to its original position. At the end, the incision is closed with stitches and gauze is placed in the external auditory canal. If otosclerosis is found in both ears, the one with the more extensive hearing loss is operated on first, and the next procedure is usually performed one year after the first.

Stapedectomy: Results of surgery

Stapedectomy is performed under general anesthesia by an experienced otorhinolaryngologist, and aims to improve the patient’s hearing. The improvement is immediately noticeable by the patient, and shows a gradual improvement during the next 2-3 months. The duration of the procedure amounts to one to two hours, while the patient is discharged after 2 days of hospital stay. The patient is given ear drops and antibiotic medication until the gauzes are removed. ENT Surgeon in Athens Dr. Olga Papadopoulou performs this operation in order to effectively and definitively treat otosclerosis.