Otosclerosis and Stapedectomy
This page was last updated on: April 24, 2014
In a normal ear (see left) , drum vibrations move the malleus (hammer) which is connected to the incus (anvil).  The stapes (stirrup) transmits sound vibration from the incus to the inner ear fluids.
Otosclerosis is a deposit of new bone ( depicted in white) that prevents the footplate of the stapes from moving, thus causing hearing loss.
In a stapedectomy, the stapes is removed and a prosthesis is placed to transmit sound vibration from the the incus (anvil), to a fat plug (fascia or vein) in the oval window of the inner ear.
Informed Consent for Stapedectomy
Post-Op Information for Stapedectomy
Pictures and Anatomy of the Stapes
PICTURES OF VARIOUS EAR CONDITIONS
Stapedioplasty (see photograph below)

In this diagram, the stapes has been removed, and a small piece of fat from the ear lobe has been used to "plug" the oval window and prevent perilymph from leaking into the middle ear. Gelfoam, temporalis fascia, vein and tragal perichondrium have all been successfully used in stapedectomy. 

A Robinson stainless steel prosthesis is placed between the lenticular process of the incus  and the fat plug in the oval window.  The bucket handle of the prosthesis is rotated over the incus to prevent the prosthesis from slipping.

The system is finally tested by moving the malleus and incus with a Rosen needle and observing a corresponding movement in the light reflex of the fluid or blood accumulated in the round window niche.  The movement of the light reflex confirms the integrity of the reconstructed osscular chain.

When a stapedectomy is done under local anesthesia, an immediate marked improvement in hearing is noticed by the patient.
STAPEDECTOMY (Left ear, surgeon's view)
The replacement of the stapes with a prosthesis is sometimes called stapedioplasty.  In this photogtaph, a titanium bucket prosthesis is used to replace the stapes.
Diagram showing a Robinson prosthesis on fat.  Note the proximity of the facial nerve,
Anatomy of the Middle Ear
STAPEDECTOMY (Right ear, surgeon's view)
Like the previous photograph, this one again shows the titanium bucket prosthesis in place.  The chorda tympani was retracted anteriorly and is visible at the posterior edge of the tympanomeatal flap.
STAPEDECTOMY (Right ear, surgeon's view)
This photograph shows the light reflex in the round window.  After placing the prosthesis, the reconstructed ossicular chain assembly is tested by moving the malleus with an instrument.  If the round window light reflex moves, it indicates that the movement is transmitted from the malleus to the inner ear fluids.
OTOLARYNGOLOGY HOUSTON

Bechara Y. Ghorayeb, MD
Otolaryngology - Head & Neck Surgery

Memorial Hermann Professional Building
1140 Business Center Drive, Suite  560
Houston, Texas 77043
For appointments, call: 713 464 2614