stapedectomy

1. stapedectomy Kelsey Carter

2. Anatomy • Ear • Stapes • Tympanic membrane • Ossicles • Incus • concha

3. pathophysiology • Stapedectomy is the surgical intervention of choice for patients with otosclerosis. • Otosclerosis: • Bony over growth of the stapes • Foot plate becomes fixed in the oval window preventing normal sound vibrations from entering the ear. • Hereditary, mostly in women.

4. Surgical intervention • Positioning: • Supine. • Patient’s arm on the operative side may be tucked while other arm may be extended on an arm board. A donut may be placed under head. • Instruments: • Ear instrument set • Sterile components of ear drill • Universal ear speculum holder

5. Surgical intervention • Supplies: • Basic pack • Basin set • Gloves • Head and neck drapes • Fenestrated adhesive plastic drape • Microscope drape • Micro wipe • Suture accodring to surgeon’s preference • Dressing materials according to surgeon’s preference • Pharmaceuticals according to surgeon’s preference • Bulb syringe • Prostheses • Blade #15

6. Surgical intervention • Draping: • Patient may be draped with 3-4 sterile towels placed around the operative ear. • A sterile adhesive drape may be placed • Head is draped with a disposable sheet. • Two folded towels may be placed at the patient’s neck. • A split or drape sheet is placed to cover the patient’s body.

7. Surgical intervention • Prep: • Cleanse the operative ear, extending form the hairline to the shoulder and well beyond the midline of the face. • Prep well behind the ear on the operative side. • Caution should be taken to avoid the pooling of prep solution in or around the eyes and ears. • Surgeon may request that 1” of hair be clipped/shaved behind the ear and that the remaining hair be taped out of the operative field. • Prepped site should be dried well in order for the adhesive ear drape to stick. • Cotton may be placed inside the operative ear.

8. procedural steps • A graft may be harvested from the ear, hand, or a portion of the abdomen prior to the start of the procedure. The graft will be used to cover the oval window. A fat, perichondrium, vein, or fascia graft may be utilized. • External ear canal is injected with local anesthetic. • The operative microscope is used to visualize the middle ear. • The external ear canal is irrigated and suctioned with a 7-Fr Frazier suction for further visualization • Surgeon inserts an ear speculum, starting with a small speculum and advancing to a larger one. • Surgeon may elect to suction with a 5-Fr Frazier or microscution tip to remove any fluid from the ear • The tympanomeatal flap is created by using a roller knife, sickle knife, or flap knife. • The tympanic membrane is elevated and the posterior bony ledge removed using a house knife, duckbill elevators, or a drum elevator. Once the tympanic membrane is elevated. The surgeon is able to visualize the ossicular chain. • If surgeon is unable to visualize the ossicles due to a bony ledge , a drill may be used to remove enough bone for proper visualization. • Surgeon may elect to measure the distance from the incus to the stapes footplate or may wait until after the stapes is removed.

9. 11)Incostapedial joint is disarticulated using a house or guilford-wright joint knife. Laser may be used to perform this step of the procedure. The stapedial tendon is severed with bellucci scissors • A fine rosen needle and microcupped forceps are utilized to fracture the stapes superstructure. • Surgeon may ensure hemostasis by using tiny sponges that have been soaked in epinephrine. • Surgeon creates an opening in the footplate with a laser, drill, or sharp footplate pick. • Surgeon inspects the oval window and the graft is placed with an alligator forceps. • The prosthesis is introduced into the middle ear on alligator forceps to be positioned so it rests against the oval graft. • Wire is positioned over the incus by using a Hough hoe, picks, or footplate hooks. Once surgeon is satisfied with the position, the wire is crimped onto the long process of the incus. • At this point surgeon may test patients hearing by whispering to patient • Moistened gelatin squares may be placed around the site of the prosthesis for stability. • Tympanomeatal flap is replaced using a duckbill elevator, rosen needle, or drum elevator • The external ear canal may be packed with moistened gelatin sponge, antibiotic gel, or antibiotic ointment • Cotton is placed in the concha of the ear and the graft site is dressed. • A glasscock or mastoid dressing may be utilized.

10. Prognosis • Patient is expected to return to normal activities within 2 weeks.

11. complications • Dizziness • Tinnitus • Taste disturbances • Loss of hearing • Eardrum perforation • Temporary weakness of the facial muscles

12. Alternative Procedure • Stapedotomy • Small opening is created in the fixed stapes footplate with a small drill or a laser. • Allows for transmission of sound waves or placement of the prosthesis.