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This hypothetical consultation about otosclerosis is presented for purposes of general information. The following hypothetical consultation is not medical advice. If you think you may have this condition, please see your doctor to discuss your individual case and the exams and treatments that are best for you.
Patient: I am having increasing difficulty hearing conversations, and when talking on the telephone. I had my hearing checked by my primary care physician and he told me I had a conductive hearing loss.
Doctor: I would like to know more about the problems with your hearing. Are they predominantly on one side or the other?
Patient: I first had problems with my left ear about five years ago, and now my right ear is affected too. I decided to see if anything could be done about it because I use my right ear to talk on the phone. I’m getting worried that I may be going deaf.
Doctor: Have you ever had ear infections?
Doctor: Do you having ringing in your ear?
Doctor: Do your ears ever drain fluid?
Doctor: Do you ever have dizzy spells or feel the illusion of motion when you know that you aren’t really moving?
Doctor: Has anyone in your family had hearing problems?
Patient: Actually, now that I think about it, my mother had a problem with her bones in her ear (ossicles). She said the stapes was stuck and her doctor had to break it loose so that she could hear again. Do you think I could have the same problem?
Doctor: Some types of hearing loss can run in families. Looking at your hearing test, you have a symmetric conductive hearing loss of 30-40 dB in both of your ears. When I perform the tuning fork test, your forks confirm the presence of a significant conductive hearing loss. Your clinical picture is very suggestive of a hereditary form of hearing loss called otosclerosis.
Patient: What is otosclerosis?
Doctor: Otosclerosis is a condition that affects the stapes footplate, the hearing bone that sits on the oval window, and transfers sound energy from the middle ear to the inner ear. In patients with otosclerosis, the stapes can become fixed to the oval window so it no longer vibrates smoothly, resulting in what we call a conductive hearing loss.
Patient: Are there any tests that can confirm the diagnosis?
Doctor: Excellent question, but no, there are no good tests for otosclerosis. Occasionally a high resolution temporal bone CT can help confirm the diagnosis, but the only way to know for sure is to perform a middle ear exploration and check the mobility of the stapes.
Patient: If you go in there and find out that the stapes is fixed, can you fix it at the same time?
Doctor: Yes. The procedure is called a stapedectomy, where we remove the suprastructure of the diseased stapes, and create a small hole in the middle of the foot plate. We then insert a prosthesis that functions as a new stapes and won’t fuse with the bone around the oval window.
Patient: What is the success rate of this procedure?
Doctor: This procedure closes the air-bone gap, improving your hearing over 90% of the time.
Patient: What are the risks?
Doctor: The most common risk is a change in the taste of the anterior third of your tongue; this is often temporary and can happen in up to a third of patients. This is caused by irritation or injury to a small nerve that runs directly under the eardrum. The other risks of ear surgery include bleeding, infection and dizziness. Three fairly serious risks include facial weakness, hearing loss and severe dizziness. These happen less than 1 percent of the time.
Patient: How long does the surgery take, and will I need to stay in the hospital?
Doctor: The surgery takes 1-2 hours, and patients are able to go home the same day. It can be done under local anesthetic, and you will be awake to hear the results at the end of the procedure. We will then place packing in your ear; so do not be alarmed that you cannot hear very well the first week. We will remove the packing at your first post-operative visit. Expect to be a little dizzy the first day or two, and plan to have someone drive you to the hospital and home again after the procedure. You will receive antibiotics for one week, and pain medication, although pain is generally minimal.
Patient: Can I get both ears fixed at the same time?
Doctor: I recommend we do one ear first; and once it is healed and you are happy with the results, we can do the second ear 3-6 months later.
Patient: Do I have any alternatives?
Doctor: Yes, you may purchase hearing aids.
Patient: I feel like I am too young to be wearing hearing aids, and I can’t go in the water with them. Thank you for taking the time to explain everything to me. I would like to proceed with the surgery.
Doctor: Very well. My nurse will check with your insurance company to obtain approval and then find a date that will suit you.
Two weeks later the insurance company approves the stapedectomy. The patient is scheduled for surgery. One week prior to surgery the patient returns for a preoperative evaluation.
Doctor: Well, it looks like your insurance company has approved the surgery.
Patient: I am looking forward to getting this done.
Doctor: We will complete a history and physical at this visit, and give you a chance to meet your anesthesiologist.
Patient: What do I need to do before my surgery?
Doctor: You will need to stop all aspirin and non-steroidal anti-inflammatory medications, which include Motrin, ten days before your surgery. Be sure not to eat or drink anything after midnight the night before your surgery. The anesthesiologist may let you take your blood pressure and heart medications with a small sip of water; but other than that, the morning of surgery you should not have any food or drink.
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