Otosclerosis

Otosclerosis surgery is performed under general anesthesia by your ENT surgeon on an outpatient basis, except in the case of immediate complications that require a longer hospital stay.

Find out more about Doctor Delagranda’s otosclerosis surgery below, ENT and cervico-facial surgeon in La Roche sur Yon.

The eardrum is a vibrating membrane that separates the outer ear from the middle ear, and serves as the attachment for a first ossicle: the malleus. The hammer itself is linked to the anvil, which is attached to the stirrup. The stirrup is articulated to the inner ear at its plate. Otosclerosis is most often an autosomal dominant hereditary disease with variable expression, meaning that one child in two, regardless of sex, can be affected with varying degrees of signs. There are also sporadic cases, with no family history of the disease. External factors (measles virus, autoimmunity, geographical regions, fluoride content of water, etc.) are still poorly identified as triggers for the onset of the disease. Hormonal impregnation is also an important factor, since women are 2 times more affected than men, particularly during and immediately after pregnancy. Moreover, the responsibility of hormonal treatments and contraceptive pills is the subject of debate among scientists and doctors. Ethnic origin is also important, as the disease mainly affects whites, rarely Africans and exceptionally Asians. The disease most often appears between the ages of 20 and 40, on one or both sides (50%), and affects 0.1-2% of whites. Otosclerosis is a bone disease peculiar to the human species, caused by spontaneous, anarchic bone renewal, creating foci of poor-quality bone known as dystrophic otosclerosis, exclusively on the bone surrounding the inner ear (the otic capsule). These otosclerotic foci may be located in the stapedo-vestibular joint, creating a progressive blockage of the stapes, which can no longer vibrate and thus transmit sound correctly, leading to conductive deafness. In time, otosclerosis can also cause hearing loss through the inner ear, a condition known as labyrinthization. In addition to hearing loss, patients may experience permanent or intermittent tinnitus (perception of noises in the ears).The diagnosis is made in the presence of conductive hearing loss in a normal eardrum, and is confirmed by CT scan, although otosclerotic foci are not always visible.

The procedure is performed under general anesthesia in the operating room, either as an outpatient or after a 2-day hospital stay. A tiny 1 cm skin incision is made in front of the ear, if the ear canal is not used. The eardrum is lifted, and the bony frame of the canal is reamed out, so that the stirrup, the bottom of the incus and the facial nerve are clearly visible. The incus and stapes are gently disengaged. The anterior and posterior branches of the stirrup are laser-cut. The upper part of the stirrup is recovered with forceps. The stapes plate, blocked by otosclerosis, is partially or totally laser-cut. A silicone ossicle prosthesis
is placed in the hole and attached to the descending limb of the incus. The eardrum is replaced, and a healing dressing is placed in the ear canal for 10 to 15 days.

If you are hospitalized as an outpatient, you can go home the same day, or the following day.
After hospitalization, you must remain at home for 10 days, resting and not putting any liquid in your ear other than the prescribed drops.
The surgeon will give you 10 to 15 days off work.
Sport is not recommended for the first 15 days, and should be resumed gradually.
Swimming and diving are not recommended until your surgeon has advised you.
Flying is not recommended for 2 months.
Pain is slight, sometimes increased when chewing. It is soothed by class I analgesics such as paracetamol, and usually disappears within a week.
Post-operative care at home: ear drops to keep the healing dressing moist and effective, ear protection, analgesics, nursing care of scar.
Scar: It may be in the ear canal, or just 1 cm in front of the ear, hidden behind the hairline.

Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for otosclerosis in La Roche-sur-Yon.