In this lengthy post, I will detail my personal opinions and experience with Stapedectomies.
If you are looking for a quick one liner weather to have the operation, this is not for you. If want to make an informed decision and are willing to spend some time read on! Since this disease is somewhat of a nitch, you will not find many clear and consise answers. Based on my experience, blindly taking the advice of a single ENT is not wise.
Start your research with a few background links:
You can’t go wrong with a wikipedia article for background on this disease.
This is a very technical paper that talks about the procedure. I am somewhat reluctant to post it as a reference, because it can scare you off! Complications can occur and if you want to know the details of what CAN go wrong, this is the spot.
A priceless series of videos by Dr.W.Lippy the undisputed king of stapedectomy procedures. Once you have some background you should watch every single video!
The strain of otosclorosis affecting my family is quite severe with heavy inner ear involvement. My father was profoundly deaf in his 30s, my sisters loss is severe at about age 50, she is presently a borderline candidate for a CI. Both of them and I have inner ear involvement for which a stapedectomy will not help.
My hearing (particularly the inner ear) is considerably better then either of theirs by luck or due to fluoride and biphosphate treatments for the disease I have been taking for the last 15years. So my first advice if you have this disease is to seek out an ENT who is familiar with these treatments. In my queries to ENTs about long term degraded hearing for stapedectomy patients, several have said the progression of inner ear loss is what the long term problem is. So even if you have a successful stapedectomy, it is possible you will continue to lose hearing via inner ear loss.
Since I did have a significant conducted loss, I had a primary stapedecomy in my left ear in 1991 by a very prolific surgeon (15000+ operations!) in NY city. Like all surgeons, he claimed a 90+% success rate for the procedure. The operation was successful with the air bone gap closed to within about 10dB. About 9 months later, my hearing degraded substantially with the loss being mostly conducted. I elected to have a revision with the same surgeon in 1993. The problem was that the prosthetic had eroded the incus and it had slipped out of place. This surgeon used a ‘wire and piston’ prosthetic, and he recrimped a new one, a little further up the incus. For a week or two, it stayed in place, but it slipped out of place shortly thereafter and my air-bone gap widened to 40+dB.
When the ENT treating me with biphosphates retired in the summer of 2009, he (once again!) recommended I have a revision stapedectomy tobe performed by Dr.Lippy. I had been ignoring this advice for years due to the two failed operations, but since this was his parting visit with me, I decided to dig a little deeper. As luck would have it, Dr.Lippys video library (referenced above) was just coming online.
These videos are extremely educational and convinced me that a revision really did have a chance to succeed. When I went to a local surgeon around 1997, he said I would have an 80% chance of a successful revision. No explanation, no comment on the prior surgical reports, just ‘trust me this will be great’. Sorry Doc, but I need a little more confidence. The videos library covered the depth I needed to proceed and you also get the sense that the techniques the particular surgeon uses are important to long and short term success.
I had another revision done by Dr.Lippy in 10/09. He characterized the operation as a text book case of an easy, eroded incus. I have posted a 4 minute rended down video of my actual operation at http://www.youtube.com/watch?v=ewfHuXETMLs . The surgery was successful, I am now 2 month post op and there has been no degradation of hearing. My results are posted in my siggy both pre and post op. The air-bone gap was closed to within 10dB up to 3KHz… Since the incus had to be trimmed (less mechanical advantage), this is an excellent result. I am hoping the 15dB gap I have at 4K closes a little bit more in the coming months, but even without it I am elated at the results.
My loss in the restored ear (which is now my good ear by far) is still bad enough that I should wear a hearing aid in that ear. This is due to inner ear loss. For now I am not wearing an instrument in that ear but will probably get another audiogram and get an open fit instrument at 6 month post op. Twice in the last month I was out and about when I realized that I had forgotten even to put in one hearing aid and had not noticed for an hour or two. Pre-op I was basically nonfunctional in speech listening without one instrument in. Hearing loss is such that having just one good ear is a big benefit. The sudden restoration of 30dB of hearing can actually be startling! Minor side effect of surgery: My wifes snoring sometimes keeps me awake!
The key question in having the procedure is to weight the benefits vs the risks. If you air bone gap is small, say 10 or 20dB, there is potential for noticeable gain. Remember that a ‘success’ is to close the gap to within 10dB. If you have 10dB gap pre and post op, guess what? The doc chalks up a successful operation, yet your hearing is unchanged. BTW, you have just had one of you inner ear bones destroyed, hopefully there will be no complications with the prosthetic! I would not consider having the operation if my gap was 20dB or less unless the inner ear was severely degraded (60dB or more down). If you are in this situation, even a small gain will give you a significant increase in dynamic range. If the surgery is successful you should be able to get better hearing with hearing aids.
If your air-bone gap is 40 dB or more, a successful operation will have a startling affect on your hearing. The surgery does have it’s risks, but the potential for gain is huge, so it is worth taking in my opinion. Be sure to pick a surgeon experienced in this procedure. The surgeons skill matters a lot in this operation, the stapes is smaller then a grain of rice! I would also inquire as to what prosthetic he uses. I do not know if the wire/pistons are used any more, but certainly my bad experience with them means I will never let one be put in my ear. The ‘crimping’ of this prosthetic to the incus must be done perfectly to work and have long life. The Robison (and derivative) prosthetics attachment methods seem much less risky. Present MRIs machines may be OK with a steel prosthetic, but titantium ones are available and are not magnetic, so it is best to ask for that.
So what if your air-bone gap is between 20-40db? Well, this is the grey area. I personally think the long term success rates for this procedure are overstated. I have asked 3 surgeons to reference studies on long term results on this procedure all have said they’re good, but none have provided the actual studies! Also, the restoration of frequencies above 2KHz or so is not as well assured as those at lower frequencies. If your inner ear is not so good, say 40dB or more down, it may be worth considering the operation again due to the large increase in dynamic range. Otherwise I would say wait and see what happens to your hearing.