Otosclerosis and Its Treatment (Ear Calcification)
Otosclerosis is a condition in which the bones in the middle ear grow abnormally, obstructing sound transmission and leading to hearing loss. With early diagnosis, various surgical and medical treatment methods can stop or even reverse hearing loss.
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What is Otosclerosis?
Otosclerosis is a disease that occurs when the stapes bone (stirrup bone) in the middle ear hardens abnormally. Normally, this bone moves freely to transmit sound waves to the inner ear. However, in otosclerosis, the hardening and immobilization of this bone structure prevent sound waves from reaching the inner ear, resulting in conductive hearing loss.
Why Does Otosclerosis Require Surgery?
Otosclerosis is a progressive disease, and hearing loss can worsen over time. In the early stages, hearing loss can be managed with hearing aids; however, this does not stop the progression of the disease. If hearing loss becomes noticeable and negatively impacts the quality of life, surgical intervention is considered. Surgery (usually referred to as a stapedectomy or stapedotomy) involves removing the hardened bone and placing a prosthesis in its place. This prosthesis allows sound waves to reach the inner ear, correcting hearing loss. The surgery can significantly restore hearing ability and greatly improve the patient’s quality of life. Whether surgery is necessary depends on factors such as the progression rate of the disease, the degree of hearing loss, and the impact on the patient’s quality of life. Doctors evaluate individual cases and recommend the most suitable treatment path for their patients.
What Will Happen During the Surgery?
The procedures performed during otosclerosis surgery generally include the following steps:
1. Anesthesia:
The surgery is usually performed under general or local anesthesia. If local anesthesia is preferred, the patient remains awake but has the ear numbed, so no pain is felt during the procedure.
2. Accessing the Ear Canal:
The surgeon makes a small incision in the ear canal while working under a microscope. This incision provides access to the middle ear.
3. Examination of the Stapes Bone:
The surgeon examines the stapes bone (stirrup bone) affected by otosclerosis to confirm the degree of hardening and immobility.
4. Removal of the Stapes Bone:
During a stapedectomy, the hardened stapes bone is completely removed. Alternatively, in a stapedotomy, only part of the bone is removed, or a small hole is made in the bone.
5. Placement of the Prosthesis:
After the stapes bone is removed, a small prosthesis is placed in its position. This prosthesis is designed to transmit sound waves to the inner ear. It is placed at the oval window (the entrance to the inner ear) and connects with the other bones to enable sound transmission to the inner ear.
6. Closing the Incision:
After the prosthesis is placed and tested, the surgeon closes the incision in the ear canal. Any bleeding is controlled, and the surgical area is cleaned.
7. Recovery and Testing:
After the surgery is completed, the patient is taken to a recovery room. During the recovery period, hearing tests may be conducted to ensure the prosthesis is functioning correctly and that hearing is improving.
The surgery typically takes 1-2 hours, and most patients can be discharged the same day. However, in some cases, an overnight stay in the hospital may be required. In the first few weeks after surgery, hearing may be slightly muffled, but this gradually improves over time.
Frequently Asked Questions About Otosclerosis:
How long does the surgery take?
Otosclerosis surgery typically takes 1-2 hours. However, with preparation and recovery time, the overall hospital stay may be slightly longer.
What is the success rate of the surgery?
The success rate of otosclerosis surgery (stapedectomy or stapedotomy) is quite high. Generally, 90-95% of patients experience significant improvement in hearing after surgery. Success rates may vary depending on factors such as the surgeon’s experience, the progression of the disease, and the patient’s overall health.
Success rates can be summarized as follows:
- Hearing Improvement:
The majority of patients who undergo the surgery experience a substantial improvement in hearing, approaching normal levels. They particularly notice better hearing of low-frequency sounds. - Risk of Complications:
Complications are rare but carry a minor risk during or after surgery. These may include failure to improve hearing, dizziness, facial nerve damage, or infection. However, such complications generally occur at a low rate, around 1-2%. - Long-Term Success:
The long-term success of the surgery is generally high as well. When prostheses are well-positioned, most patients enjoy the benefits of the surgery for many years. However, in rare cases, a second surgery may be necessary due to prosthesis displacement or progressive otosclerosis.
Overall, otosclerosis surgery is considered a highly effective and safe option for correcting hearing loss. Patients should discuss all risks and expectations in detail with their surgeon before the surgery.
What is the Recovery Process After Surgery?
The recovery process after otosclerosis surgery usually varies from a few weeks to several months. There are some important points to keep in mind during recovery:
Hospital Stay and First Days:
The surgery is usually done on an outpatient basis, meaning most patients are discharged the same day. However, in some cases, particularly if general anesthesia was used or there’s a risk of complications, a one-night stay in the hospital may be required.
After surgery, symptoms like dizziness, a feeling of fullness in the ear, mild pain, and imbalance may be experienced. These symptoms typically decrease within a few days.
First Weeks:
There may be mild discharge or bleeding from the ear after surgery, usually resolving within the first few days.
Hearing may not improve immediately after surgery. During the first weeks, there may be a feeling of fullness or blockage in the ear. This could be due to fluid buildup in the inner ear or swelling in the surgical area and should improve over time.
Ear Care:
Your doctor may advise you to keep your ear dry after surgery, which is particularly important while bathing or swimming, as water can increase the risk of infection.
The bandage or packing in the ear canal should remain in place for the period specified by your doctor, typically lasting a few days to a week. After the bandage is removed, it is essential to keep the ear canal clean and dry.
Hearing Improvement:
Hearing gradually improves after surgery. Some patients may notice immediate improvement, while others may need to wait a few weeks or months for full recovery.
A hearing test is conducted after surgery to monitor progress.
Physical Activity:
It is important to avoid strenuous physical activities, heavy lifting, and sudden head movements for the first few weeks after surgery. Such activities could cause the prosthesis to shift or damage the inner ear.
Avoid situations that can cause pressure changes, like air travel, during the initial weeks.
Dizziness and Balance Issues:
Some patients may experience dizziness and balance issues for several weeks after surgery. This is usually temporary and improves over time. However, if you experience severe dizziness or balance problems, consult your doctor.
Follow-Up Appointments:
Several follow-up appointments are scheduled after surgery. During these visits, your doctor will evaluate your recovery progress, test your hearing, and check for any complications.
Long-Term Care:
The effects of the surgery are generally permanent, but in some cases, a second surgery may be necessary due to prosthesis displacement or other complications. Therefore, if symptoms such as hearing loss, fullness in the ear, or dizziness return, you should contact your doctor.
Following your doctor’s instructions closely during this process is essential to speed up recovery and minimize the risk of complications.
What Are the Complications After Surgery?
Complications are rare.
- Hearing Loss:
Although the purpose of the surgery is to correct hearing loss, in rare cases, hearing loss may worsen. This can occur due to damage to the inner ear during surgery or improper placement of the prosthesis. - Dizziness and Balance Issues:
Temporary dizziness is a common side effect after surgery. Most patients overcome these symptoms within a few days to a few weeks. However, in some cases, dizziness may persist or become severe, leading to balance issues. - Tinnitus (Ringing in the Ears):
The sensation of ringing or buzzing in the ears (tinnitus) may increase after surgery. While this is temporary for some patients, in rare cases, it may become permanent. - Facial Nerve Damage:
Since the surgery is performed near the facial nerve in the middle ear, there is a risk of damage to this nerve during surgery. This could cause weakness or paralysis on one side of the face, although this complication is very rare. - Taste Disturbances:
During ear surgeries, the chorda tympani nerve, which affects taste, may be damaged. This can lead to taste disturbances on one side of the tongue or a metallic taste sensation. This condition is usually temporary but can rarely be permanent. - Infection:
As with any surgical procedure, there is a risk of infection at the surgical site. Signs of infection may include redness, swelling, pain, and discharge from the ear. Infections are typically treated with antibiotics. - Eardrum Perforation:
During or after surgery, the eardrum may be damaged, resulting in a perforation. In this case, an additional surgical intervention may be necessary. - Prosthesis Displacement:
The inserted prosthesis may become displaced or malfunction over time. This can lead to hearing loss, and a second surgery may be required to reposition the prosthesis. - Serous Labyrinthitis:
Inflammation may develop in the inner ear after surgery, causing dizziness and hearing loss. This condition is known as serous labyrinthitis and is usually temporary. - Cerebrospinal Fluid Leak:
A very rare complication, cerebrospinal fluid leakage, can occur if a thin membrane between the inner ear and the brain is damaged. This condition requires immediate medical attention. - Allergic Reactions:
Allergic reactions to anesthesia or other medications used during surgery may develop. Although rare, these reactions can be potentially serious.
Before otosclerosis surgery, your surgeon will inform you about these risks and take necessary precautions to minimize complications. If you notice any signs of complications, it is important to contact your doctor immediately.
When Will Hearing Improve After Surgery?
Hearing improvement after otosclerosis surgery (stapedectomy or stapedotomy) usually takes a few weeks to several months. The recovery time and exact timing of hearing improvement may vary for each patient.
First Days After Surgery:
You may not notice a significant improvement in hearing immediately after surgery. In fact, some patients may experience a feeling of fullness or blockage in the ear during the first few days. This can be due to residual fluid, swelling in the inner ear, or bandages.
Mild dizziness, ringing in the ear (tinnitus), and balance issues are also normal after surgery.
First Few Weeks:
Hearing may start to gradually improve within the first few weeks, but it may not fully return to normal during this period. A slight feeling of fullness in the ear may still persist as the healing process continues.
When bandages or packing are removed, you may notice some improvement in hearing, but hearing levels will continue to get better over time.
One Month:
By around one month after surgery, noticeable improvement in hearing may occur. Many patients report that their hearing has significantly improved by this time, though full recovery may still take more time.
Your doctor may perform a hearing test to assess how your hearing is progressing during this period.
Full Recovery (3-6 Months):
Full hearing improvement generally takes between 3 to 6 months. During this time, your hearing stabilizes, and the full results of the surgery become more apparent.
For some patients, this process may occur faster, while for others, it may take slightly longer.
Long-Term Improvement:
Even months after surgery, gradual improvement in hearing may continue. Some patients observe that their hearing improves further over time as the prosthesis settles and the inner ear tissues fully heal.
Hearing Tests:
Several follow-up appointments are scheduled after surgery, during which hearing tests are conducted. These tests evaluate how much the hearing has improved and the success of the surgery.
In summary, hearing improvement after otosclerosis surgery is generally a gradual process. Hearing may not improve in the first few weeks, but noticeable improvement is expected over time. If you have any concerns or if the recovery process takes longer than expected, it is important to consult your doctor.
What Should Be Considered After Surgery?
There are some important points to keep in mind during the recovery period following otosclerosis surgery. These recommendations will help reduce the risk of post-surgery complications and speed up the recovery process:
Ear Care
- Keeping the Ear Dry: It is essential to keep your ear dry for the first few weeks after surgery. Be cautious when bathing to prevent water from entering your ear. Use protection as recommended by your doctor when washing your ear.
- Bandages and Packing: The bandage or packing placed in your ear after surgery should be removed according to your doctor’s instructions. Not removing these materials yourself reduces the risk of infection.
Physical Activity
- Avoid Heavy Lifting: Refrain from strenuous physical activities and heavy lifting during the first few weeks. Such movements can cause the prosthesis to shift or damage the inner ear.
- Avoid Sudden Head Movements: Avoid sudden head or neck movements, especially bending over or jumping.
- Exercise: Light activities like walking are allowed, but avoid high-impact activities and exercises (such as running or jumping).
Avoiding Pressure Changes
- Air Travel: Avoid air travel for the first few weeks, as pressure changes can cause discomfort in the inner ear or displace the prosthesis.
- Deep Diving: Avoid diving, as the pressure underwater can harm your ear.
Dizziness and Balance Issues
- Move Slowly: Dizziness after surgery is common. Move slowly when standing up or getting out of bed, and use support to reduce the risk of losing balance.
Medication Use
- Use Medications as Prescribed: Take the antibiotics, pain relievers, or other medications prescribed by your doctor regularly. These medications help reduce the risk of infection and manage pain.
- Medication Side Effects: Be aware of potential side effects and contact your doctor if you notice anything unusual.
Follow-Up Appointments
- Follow-Up Checkups: Your doctor will schedule several follow-up appointments after surgery. Attending these is important, as the doctor will assess your recovery process and detect any possible complications early.
- Hearing Tests: Hearing tests may be performed during follow-up appointments to evaluate how much your hearing has improved and ensure the prosthesis is working correctly.
Watch for Signs of Infection
- Infection Symptoms: If you notice excessive pain, redness, swelling, or discharge from your ear, this may be a sign of infection. Contact your doctor immediately if this occurs.
Avoid Swimming and Water Activities
- Swimming: Avoid swimming for the first few weeks after surgery. Swimming in pools, lakes, or the ocean may allow water into your ear, increasing the risk of infection.
Sound and Noise Levels
- Avoid Noise: Stay away from loud environments after surgery. Loud noise can put stress on the inner ear while it’s still healing.
Following these recommendations will help you have a more comfortable and safe recovery period after otosclerosis surgery. If you have any concerns or questions, be sure to consult your doctor.
Are There Non-Surgical Treatment Options?
Yes, there are non-surgical treatment options for otosclerosis; however, these treatments are generally used to slow the progression of hearing loss or manage symptoms. Non-surgical treatments may be more suitable for patients in the early stages of the disease or those not eligible for surgery. Here are the non-surgical treatment options:
Hearing Aids:
- Use of Hearing Aids: Hearing aids are commonly used to compensate for the hearing loss caused by otosclerosis. These devices amplify sounds, helping the patient hear better.
- Suitability: Different types of hearing aids may be used depending on the degree of hearing loss. They are a good option, especially for patients who do not want surgery or are not suitable candidates for surgery.
Tinnitus Management:
- Tinnitus Maskers: Otosclerosis can be accompanied by ringing in the ears (tinnitus). In such cases, tinnitus maskers or sound therapy can help reduce the impact of the ringing.
- Stress Management: Tinnitus can worsen with stress, so stress management techniques can also help manage tinnitus.
Observation and Regular Checkups:
- Observation: Early-stage otosclerosis is often managed with close monitoring and observation. Regular hearing tests and checkups are done to determine whether the disease is progressing.
- Evaluation of the Condition: If hearing loss progresses or symptoms worsen, surgery may become a more appropriate option.
Non-surgical treatment options are generally used to manage the symptoms of otosclerosis or slow the progression of the disease. However, these treatments are not as effective as surgery and cannot completely restore hearing loss caused by otosclerosis. In any case, consulting an ENT specialist is essential to determine the most appropriate treatment option.
Might the Surgery Need to Be Repeated?
Although rare, a second surgery may be required if the prosthesis becomes displaced or due to the progression of otosclerosis.
These questions are typically discussed in detail between the patient and doctor before the surgery. Since each patient’s specific circumstances may vary, it is important to seek personalized medical advice.
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Anesthesia Type: General
Operation Time: 2-3 Hours
Pain: Mild
Length of hospital stay: 1 night
Recovery Time 7 days
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