Could this be symptoms of my stapedotomy failing?

Hearing Loss
#1

Hello! I have otosclerosis in both ears and I underwent stapedotomy surgery in 2019 on my left ear. Everything went well. During recovery (about 1 month in) I noticed that my ear would often trigger some kind of broken speaker sound which amplified voices and made them distorted. I asked my surgeon about this and he said that it was probably just the healing process. The symptoms subsided within the next 2 months and my left ear has been great for the last 3 years.

A few weeks ago I’ve noticed that these symptoms has returned and they are even more noticable this time. When I wake up in the morning everything is typically fine, but as the day goes on I notice that my hearing is fluctuating. Sometimes my hearing will fluctuate every 3-4 seconds and also trigger the broken speaker distortion. When the distorsion is triggered it usually stays the rest of the day more or less until I go to sleep and it reset.

Could this be symptoms of my stapes prothesis? I’ve tried to search for symptoms of stapes surgery failure but theres not much to find. Has anyone here experienced or heard of anything simular?

Thanks in advance!

#2

I think probably. I had a stapedectomy (actually a stapedotomy) for otosclerosis 18 months ago and found that once healed, the loss in that ear varied quite a bit during the day. Also as mine is a mixed loss, caused by calcination of my cochlea, my newly restored hearing in that ear included quite a deal of distortion in the higher frequencies. After a year my loss got much worse suddenly, although fiddling in my ear canal with the power dome on the receiver, I found I could momentarily get the loss back to normal again.

I saw the surgeon again and he said I needed a “revision”. This was done a month later and talking to him afterwards he said that the prosthesis had come out of the hole in the stapes footplate and that hole had started to heal over.

It’s now six months from the revision surgery and I notice how the loss is quite unstable in that ear. I think that the issue is for the surgeon to position the prosthesis on the shaft of the incus so that it stays in the hole in the footplate and doesn’t have any slack. Also that it’s not overtight so the prosthesis gets to a place where it can’t move any more, causing clipping. But I haven’t discussed this with him again yet. I don’t really want a second revision if I can avoid it.

Anyway I think it would be worth you seeking advice from an ENT surgeon. Maybe with imaging they could tell you what is happening.

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#3

I also have otosclerosis. I had stapedotomy surgery in my right ear 20 years ago. What I am gonna say is personal, perhaps even biased… but it is what I feel in my heart of hearts… I would never, ever do the same in my left ear. Hearing aids are so much better than a piece of gold (in my case) or titanium, etc. With both ears aided, my left ear is just so much better than my right one… it is a night and day sort of difference.

I also hear a lot of distortion in my right ear in very loud places. Sometimes I hear a weird noise whenever I open my mouth, then it goes away for months. By this day I still have no idea what triggers that noise.

Again, that might be just my (bad) experience. However, I think it is worth a note of caution. Between surgery + piece of metal in my ear and a good pair of modern hearing aids, I would always pick the HAs.

Apologies for my harsh words. I just wished doctors were a bit more careful addressing the cons of these surgeries.

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#4

Thanks for your reply! When you experience/experienced distortions did they come and go or would you always hear them at specific frequenses? I’m asking this because at the moment I feel like I can hear even quite loud sounds clearly, but when this happens (and it will eventually) I hear even normal sounds such as running water extremely distorted. Kind of like a radio tuning. It feels like it’s air pressure related in some way.

I will talk to my ENT about contacting the surgeon but I have a feeling it will be hard convincing them that this needs to be redone in some way.

#5

Thank you for your input! Did you ever consider or discuss the need for revision surgery with your surgeon?

I do understand what you mean. If this is a complication of my stapedotomy that is unfixable I would also feel like I’d be better off without ever have gone through with the surgery to begin with.

#6

The distortion was always there but wasn’t obvious unless those higher frequencies were loud enough to draw attention to themselves.

I think it’s worth discussing with the surgeon if you can because it shouldn’t be like you describe. Often damage to the cochlear caused by excessive bone growth in otosclerosis does give rise to one of many different negative effects at some frequencies, apart from simple hearing loss. But amplification with a hearing aid will meet the same issue. What shouldn’t happen is that the amount of loss/distortion changes in a moment in the way that you describe. It’s not a shortcoming of stapedotomy at all. It’s a mechanical problem in your middle ear.

Incidentally I don’t agree that it’s better to use heating aids than have a stapedotomy operation. It all depends on the loss (and you haven’t put yours here, so I can’t comment on it) but notwithstanding the issues, I wouldn’t go back to how it was before I had the operation. Having said that, I am not rushing to have my better ear done, even though it’s a strong candidate.

#7

Yes, I did. My old ENT and my new ENT think a revision surgery is not worth it. As things stand, I agree with them.

Something I forgot to mention: I cannot have a MRI due to the risk of having impurities in the piece of gold in my right ear. Fortunately that is not an issue with the new materials used.

#8

These days compatibility with MRI is regarded as a big deal by the ENT surgeons and after both my first operation and the revision, I was given a card that described exactly what type and batch my prosthesis was and also the magnetic field that it was good for (which is higher than current MRI scanners).

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#9

Is the substantially greater high frequency loss in your right ear, which I presume is largely sensorineural, a result of the operation or a result of more cochlear ossification on that side?

#10

Thanks for asking, @Neville. It is a result of the operation. My audiogram in the right ear has not really changed ever since the surgery.

#11

Yeah, that’s a shame. I’m sorry that happened. I’ve seen a lot of stapedectomies with very good outcomes, but for the ones where you lose rather than gain, it’s hard not to look back and regret it. And it’s always a risk. I’ve had one patient lose all hearing in the one ear after an attempted stapedectomy. The next best step for them for that ear is CI, but as you might imagine they are very hesitant to pursue further surgery.

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#12

Sorry to hear that, I may be stepping out of my bound here, I think the next best thing for you is to get a BAHA or the Cochlear Osia/ medel bonebridge implant system

#13

Update: I went to see my ENT today and he was pretty much on board with my theory until the hearing test came back without any signs of further hearing loss. I knew it would not show any hearing loss since it’s not a constant loss that I experience. And the distortions is a far bigger problem for me than the on/off hearing loss. He did contact the surgeon who did the stapedotomy and he was also doubtful, but they will discuss this tomorrow and get back to me asap. I dont really know how to convince them that this should be connected to my protesis, and I know that I should also trust their judgement. But I simply dont know anything else that could have caused these symptoms. And to ignore them is impossible.