Stapes Osteosclerosis: Impacts on Hearing and Surgery Risks

Otosclerosis

Hello Dr.
Hong: I have been experiencing hearing loss in my right ear for at least 10 years.
However, since it hasn't been a significant issue in my daily life, I never sought an examination until recently.
The results of the examination are as follows: 1.
A CT scan revealed that the stapes bone in the innermost part of my right ear has undergone sclerosis (the ossicle connected to the eardrum).
The scan showed a small white spot, which the doctor indicated is a sign of sclerosis.
2.
The hearing test results were somewhat unclear, but to illustrate, if we assume a Cartesian coordinate system: the left ear is normal, positioned at y=10, while the right ear's hearing loss is roughly between y=5 and y=8, with about 5 to 6 points along that line (I believe this corresponds to 5 to 6 different tests, as I underwent 5 to 6 tests).
The doctor provided me with three recommendations: 1.
Hearing aids 2.
Surgery 3.
Since it does not affect my daily life, to continue monitoring without making a decision for now.
I would like to ask, given my current situation, what aspects would surgery impact? I am particularly concerned about the proximity to the brain; would surgery affect my memory, intelligence, or other cognitive functions? Thank you for your response, doctor.

Xiao Wang, 20~29 year old female. Ask Date: 2008/04/04

Dr. Hong Guangliang reply Otolaryngology

Hello, based on your description, although I haven't seen your eardrum, audiogram, or CT scan, I will try to answer your questions:
1.
Given your age and description, your condition seems to be related to ossicular chain fixation.
The innermost ossicle is the stapes, which connects to the eardrum via the malleus.
I'm not sure which one you are referring to.
If it is the malleus that is fixed, the more likely causes are congenital abnormalities or congenital cholesteatoma; if it is the stapes, it could be otosclerosis.
(Do you have a history of ear infections with discharge or a perforated eardrum?)
2.
Your physician's recommendations are:
(1) Hearing aids: I would recommend this if both ears are affected, but if you have one ear that is nearly normal, the benefit may be limited.

(2) Surgery: The goal is to improve hearing, but there is also a risk of worsening the condition.

(3) Observation: Monitoring your condition and addressing it if hearing worsens is also a good suggestion!
3.
As for the risks of surgery, I am not sure what type of surgery your physician is planning, but generally, it should not affect memory or cognitive function! If you have further questions, feel free to discuss them!

Reply Date: 2008/04/04

More Info

Otosclerosis is a condition that primarily affects the stapes bone in the middle ear, leading to hearing loss. It is characterized by abnormal bone growth, which can immobilize the stapes and prevent it from transmitting sound vibrations effectively to the inner ear. This condition often manifests as conductive hearing loss, which is what you are experiencing in your right ear.
Based on your description, it seems that you have been living with this condition for over a decade without significant impact on your daily life. However, the recent imaging results indicating hardening of the stapes suggest that the condition may be progressing. The hearing tests you underwent further confirm that your right ear is experiencing a notable reduction in hearing ability compared to your left ear.

When considering surgical options for otosclerosis, the most common procedure is a stapedectomy. This surgery involves removing the immobilized stapes bone and replacing it with a prosthetic device to restore sound transmission. While surgery can significantly improve hearing in many patients, it is essential to understand the potential risks and impacts associated with the procedure.

Risks of Stapedectomy
1. Surgical Risks: As with any surgical procedure, there are inherent risks, including infection, bleeding, and adverse reactions to anesthesia. These risks are generally low, but they are still important to consider.

2. Hearing Loss: Although the goal of the surgery is to improve hearing, there is a possibility of temporary or permanent hearing loss following the procedure. This risk is particularly relevant in cases where the hearing loss is profound or when there are complications during surgery.

3. Tinnitus: Some patients may experience ringing in the ears (tinnitus) after surgery, which can be distressing and may not resolve.

4. Balance Issues: The inner ear is responsible for balance, and surgery can sometimes lead to temporary balance problems, although these typically resolve over time.

5. Facial Nerve Injury: The facial nerve runs close to the middle ear, and there is a small risk of injury during surgery, which could lead to facial weakness or paralysis.

Concerns About Cognitive Function
Your concern about the proximity of the surgical site to the brain and the potential impact on memory and cognitive function is understandable. However, it is important to note that the stapes is located in the middle ear, and the surgical procedure does not involve the brain or the structures directly associated with cognitive function. The risks of affecting memory or intelligence as a result of stapedectomy are extremely low. Most patients do not experience any cognitive side effects from this type of surgery.

Decision-Making
Given that your hearing loss has not significantly impacted your quality of life, the decision to proceed with surgery should be carefully considered. If you are comfortable with the current level of hearing and do not find it disruptive, monitoring the condition may be a reasonable approach. However, if you notice a decline in your hearing or if it begins to affect your daily activities, discussing surgical options with an otolaryngologist (ENT specialist) would be advisable.

In summary, while stapedectomy can offer significant benefits in terms of hearing restoration, it is essential to weigh the potential risks and impacts. Consulting with a specialist who can provide personalized advice based on your specific situation is crucial. They can help you understand the likelihood of success, the risks involved, and whether surgery is the best option for you at this time.

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