Thursday, October 30, 2008

Stapedectomy

It is a surgical procedure in which the stapes is removed and replaced with a prosthesis, a piston usually made of teflon/stainless steel/gold. Its a mode of treatment for otosclerosis (otospongiosis). Another procedure, stapedotomy is done sometimes (a hole is punched into the footplate of stapes and the implant fixed there).

Indications
  1. Conductive deafness due to fixation of stapes.
  2. Air bone gap of at least 40 dB.
  3. Presence of Carhart's notch in the audiogram of a patient with conductive deafness.
  4. Good cochlear reserve as assessed by the presence of good speech discrimination.
Contraindications
  1. Poor general condition of the patient.
  2. Only hearing ear.
  3. Poor cochlear reserve as shown by poor speech discrimination scores
  4. Patient with tinnitus and vertigo
  5. Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
  6. Conductive deafness due to Ehlers-Danlos Syndrome (EDS)
Complications
  1. Facial palsy
  2. Vertigo in the immediate post op period
  3. Vomiting
  4. Perilymph gush
  5. Floating foot plate
  6. Tympanic membrane tear
  7. Dead labyrinth
  8. Perilymph fistula
  9. Labyrinthitis
  10. Granuloma (Reparative)

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